胸腔积液和血液γ-干扰素释放试验在结核性胸膜炎患者中的诊断价值

Diagnostic value of pleural effusion and blood γ-interferon release test in patients with tuberculous pleurisy

目的探讨胸腔积液和血液γ-干扰素释放试验(IGRA)在结核性胸膜炎患者中的诊断价值。方法选取2016年1~12月深圳市人民医院临床症状有胸腔积液的患者151例,按临床诊断将其分为结核性胸膜炎组77例,非结核性胸膜炎组74例,分别收集患者的血液和胸腔积液样本开展IGRA,利用统计学软件分析试验对血液和胸腔积液样本的灵敏度、特异性、阴性预测值、阳性预测值以及结果的一致性。结果胸腔积液IGRA灵敏度为97.4%,特异性为73.1%;血液灵敏度为83.1%,特异性为87.7%,胸腔积液灵敏度高于血液(χ2=8.94,P<0.05),但特异性小于血液(χ2=4.74,P<0.05);胸腔积液阳性预测值为80.6%,阴性预测值为96.1%;血液阳性预测值为87.7%,阴性预测值为83.1%,胸腔积液的阳性预测值与血液的比较,差异无统计学意义(χ2=1.48,P>0.05),而胸腔积液的阴性预测值高于血液(χ2=4.98,P<0.05);两种样本检测结果一致性一般(Kappa=0.57)。结论胸腔积液和血液IGRA在结核性胸膜炎中均有一定诊断价值,胸腔积液IGRA对鉴别诊断结核性胸膜炎更有意义。

Objective To investigate the diagnostic value of pleural effusion and blood γ-interferon release test（IGRA）in patients with tuberculous pleurisy. Methods A total of 151 patients with pleural effusion from January to December2016 in Shenzhen People′s Hospital were selected and divided into tuberculous pleurisy group（77 cases） and non-tuberculous pleurisy group（74 cases） according to clinical diagnosis. Blood and pleural effusion samples of the patients were collected respectively to carry out IGRA. The sensitivity, specificity, negative predictive value, positive predictive value and consistency of the results of the tests on blood and pleural effusion samples were analyzed by using statistical software. Results The sensitivity of the pleural effusions IGRA was 97.4% and the specificity was 73.1%. The sensitivity of the blood was 83.1%,the specificity was 87.7%, and the sensitivity of the pleural effusion was higher than that of the blood（χ2=8.94, P〈0.05）, but the specificity was less than the blood（χ2=4.74, P〈0.05）. The positive predictive value of the pleural effusions IGRA was 80.6%, and the negative predictive value was 96.1%. Blood IGRA positive predictive value was 87.7%, negative predictive value was 83.1%, the pleural effusions positive predictive value compared to the blood,there was no statistically significant difference（χ2=1.48, P〈0.05）, and the pleural effusions negative predictive value was higher than the blood（χ2=4.98, P〈0.05）. The consistency of two samples was not good（Kappa=0.57）. Conlusion The pleural effusion and blood γ-interferon release test had a certain diagnostic value in tuberculous pleurisy. The pleural effusionγ-interferon release test was more meaningful for the differential diagnosis of tuberculous pleurisy.