TB-DNA和IGRAs对川西高原地区肺结核诊断的适用性分析

Applicability of TB-DNA and IGRAs to diagnosis of pulmonary tuberculosis in the western Sichuan Plateau

目的探讨结核分枝杆菌DNA(TB-DNA)和γ-干扰素释放试验(IGRAs)对川西高原地区肺结核诊断中的适用性。方法选取2018年4月至2019年5月在本院住院的510例肺结核疑似患者,其中肺结核154例,非肺结核组356例,同时行TB-DNA(荧光定量PCR法)和IGRAs(ELISA法)检查,比较两种方法在不同类型肺结核和不同类型标本中的检出率。结果 TB-DNA和IGRAs对川西高原地区肺结核的诊断灵敏度分别为42.9%、73.4%,特异度分别为98.3%、70.2%,TB-DNA在结核性胸膜炎和继发性肺结核中的检出率为21.6%和52.5%,IGRAs在结核性胸膜炎和继发性肺结核中的检出率为58.8%和80.2%,两者联合在结核性胸膜炎和继发性肺结核中的检出率为70.6%和95.0%。3者在继发性肺结核中的检出率均明显高于结核性胸膜炎(P<0.05)。TB-DNA在肺泡灌洗液中检出率最高(66.0%),其次为自然咳痰(33.8%),胸水检出率最低(11.1%),且差异有统计学意义(P<0.05)。肺泡灌洗液TB-DNA与IGRAs结果一致性最好。结论 TB-DNA和IGRAs单独用于川西高原地区肺结核的诊断均不够灵敏,选择合适的标本和共同联合检测可以提高肺结核的检出率,有利于川西高原地区肺结核的早期诊断。

Objective To explore the applicability of TB-DNA and IGRAs to the diagnosis of pulmonary tuberculosis in the western Sichuan plateau. Methods 510 patients from the plateau area of the western Sichuan from April 2018 to May 2019 in the 363 Hospital were selected,including 154 cases of tuberculosis and 356 cases of non-tuberculosis. TB-DNA(FQ-PCR)and IGRAs(ELISA)were performed simultaneously. The sensitivity and specificity of the two methods were compared and analyzed by SPSS 21.0 statistical software. The detection rates of the two methods in different types of tuberculosis and different types of specimens were compared. c2 test was used to compare the rate between groups,P<0.05,the difference was statistically significant. Results The diagnostic sensitivity of TB-DNA and IGRAs for tuberculosis in the western Sichuan plateau was 42.9% and 73.4%,and the specificity was 98.3% and 70.2%,respectively. The detection rate of TB-DNA in tuberculous pleurisy and secondary tuberculosis was 21.6 % And 52.5%,and the detection rates of IGRAs in tuberculous pleurisy and secondary tuberculosis were 58.8% and 80.2%. The combined detection rates of tuberculous pleurisy and secondary tuberculosis were 70.6% and 95.0%. The detection rates of the three different samples(alveolar lavage fluid,sputum and pleural fluid) in secondary pulmonary tuberculosis were significantly higher than those in tuberculous pleurisy(P<0.05). The detection rate of TB-DNA in alveolar lavage fluid was the highest(66.0%),followed by natural sputum(33.8%),and the detection rate of pleural fluid was the lowest(11.1%),and the difference was statistically significant(P<0.05). Alveolar lavage fluid TB-DNA and IGRAs had the best consistency. Conclusion TB-DNA and IGRAs alone are not sensitive in the diagnosis of pulmonary tuberculosis in the western Sichuan Plateau. The selection of appropriate specimens and combined detection can improve the detection rate of pulmonary tuberculosis and facilitate the early diagnosis of tuberculosis in the western Sichuan plateau.