TB-IGRA联合其他检测方法在结核筛查中的应用研究

Application of TB-IGRA combined with other detection methods in tuberculosis screening

目的探讨TB-IGRA联合其他几种检测方法在结核筛查中的应用效果。方法选择2017年1～8月我院门诊收治的795例患者,根据病情分为结核组和非结核组,均行痰涂片、痰培养、PPD皮试、γ-干扰素释放酶联免疫法(TB-IGRA)、结核分枝杆菌IgG/IgM抗体检测。统计并分析痰涂片、痰菌培养、PPD试验、TB-IGRA、IgG/IgM的开展情况、灵敏度、特异性、约登指数;分析TB-IGRA检测的特异性和灵敏度;比较TB-IGRA检测分别与PPD试验、IgG/IgM抗体并、串联检测的特异性和灵敏度。结果痰菌培养、TB-IGRA检测的开展数量最多,PPD试验开展数量最少(P<0.05),以临床判定结果为金标准,行灵敏度、特异性、约登指数比较,痰菌阳性检出率最低,仅检出5例。痰涂片、痰菌培养的灵敏度低于PPD试验,但特异度高于PPD试验,TB-IGRA检测和IgG/IgM抗体检测的灵敏度高于PPD试验(P<0.05),选择灰区范围在8.32～19.10之间的样本46例,统计分析得到TB-IGRA检测灰区范围内样本的灵敏度、特异性分为23.08%、54.55%。TB-IGRA分别与PPD试验或IgG/IgM抗体检测行并、串联分析,可显著提高检查结果的灵敏度。结论 TB-IGRA检测方法用于区域性结核筛查,灵敏度和特异性高。对于灰区样本,联合PPD试验、IgG/IgM抗体检测有助于提高检测灵敏度。

Objective To explore the application effect of TB-IGRA combined with other detection methods in tuberculosis screening.Methods 795 patients admitted in our hospital from January to August 2017 were divided into tuberculosis group and non-tuberculosis group according to the condition.All patients were treated with sputum smear,sputum culture,PPD skin test andγ-interferon release enzyme immunoassay(TB-IGRA),M.tuberculosis IgG/IgM antibody detection.The development situation of sputum smear,sputum culture,PPD test,TB-IGRA and IgG/IgM,sensitivity,specificity,Yoden index was statistically analyzed.The specificity and sensitivity of the PPD assay was analyzed.The specificity and sensitivity of the TB-IGRA assay,PPD assay,IgG/IgM antibody in parallel detection and tandem detection were compared.Results The development number of sputum culture and TB-IGRA test was the highest,and the number of PPD test was the lowest(P<0.05).The clinical judgment results were the gold standard and the sensitivity,specificity,and Yoden index were compared.The detection rate of sputum-positive was the lowest,and only 5 cases were detected.The sensitivity of sputum smear and sputum culture was lower than that of PPD test,but the specificity of sputum smear and sputum culture was higher than that of PPD test.The sensitivity of TB-IGRA test and IgG/IgM antibody detection was higher than that of PPD test(P<0.05).46 cases of gray area range from 8.32.to 19.10 were selected.Statistical analysis showed that the sensitivity and specificity of samples in the gray area of TB-IGRA detection were 23.08%and 54.55%.TB-IGRA could be combined with PPD test or IgG/IgM antibody detection in parallel detection and tandem detection,which significantly improved the sensitivity of the test results.Conclusion The sensitivity and specificity of TB-IGRA assay used for regional tuberculosis screening is high.For gray area samples,combined PPD test and IgG/IgM antibody detection help to improve detection sensitivity.