外周血干扰素-γ释放试验诊断结核性胸膜炎的假阴性影响因素分析

Influencing factors for false-negative results of peripheral blood interferon-γ release assay in patients with tuberculous pleurisy

目的探讨外周血干扰素-γ释放试验(IGRAs)诊断结核性胸膜炎假阴性的独立影响因素。方法采用回顾性分析的方法,纳入2014年1月至2019年5月在重庆医科大学附属第二医院呼吸内科住院治疗,并根据细菌学和(或)组织学确诊为结核性胸膜炎的患者144例,采集患者人口学及临床资料,根据全血酶联测定免疫吸附测定法(QFT-GIT)进行IGRAs的结果将患者分为假阴性组和阳性组,应用Logistic回归分析QFT-GIT在结核性胸膜炎诊断中的假阴性的影响因素。结果结核菌素试验(PPD)阴性结果[Exp(B)=6.451,95%CI(2.951~14.105),P=0.000]、外周血嗜酸性粒细胞(EOS)计数[Exp(B)=0.057,95%CI(0.004~0.811),P=0.034]是QFT-GIT假阴性的独立影响因素。结论对于EOS较高和PPD阴性的胸腔积液患者,若出现QFT-GIT阴性的结果,需结合临床进行综合判断,不能完全排除结核性胸膜炎可能。

Objective To investigate the independent influencing factors for false-negative results of peripheral blood interferon-γ release assay(IGRAs)in patients with tuberculous pleurisy.Methods A retrospective analysis was performed on 144 tuberculous pleurisy patients diagnosed by bacteriology and/or histology admitted to the hospital from January 2014 to May 2019.Demographic and clinical data of patients were collected.The patients were divided into the false-negative group and the positive group based on the results of IGRAs by enzyme linked immunosorbent assay(QFT-GIT).Logistic regression analyse was performed to identify the influencing factors for false-negative results of QFT-GIT in tuberculous pleurisy patients.Results PPD negative results[Exp(B)=6.451,95%CI(2.951-14.105),P=0.000]and peripheral blood eosinophils(EOS)count[Exp(B)=0.057,95%CI(0.004-0.811),P=0.034]were independent influencing factors for QFT-GIT false-negatives.Conclusion For pleural effusion patients with high EOS and negative PPD,if QFT-GIT negative result appears,comprehensive judgment should be made in combination with clinical practice,and the possibility of tuberculous pleurisy cannot be completely excluded.