3种检测方法在儿童活动性结核病诊断中的应用

Application of three detection methods in diagnosis of active tuberculosis in children

目的评价γ-干扰素释放试验(IGRA)、结核菌素皮肤试验(TST)及结核抗体(TB-Ab)检测对儿童活动性结核病的临床诊断价值,并分析IGRA及TST在不同年龄患儿中的应用价值。方法收集该院就诊的疑似结核患儿367例资料,其中临床诊断结核病患儿113例,非结核病患儿254例。分析3种方法的灵敏度、特异度、一致性及受试者工作特征曲线下面积(AUC)等。根据年龄将患儿分为不同亚组(0~<2岁组、2~<6岁组、6~<10岁组、10~15岁组),分析IGRA及TST在各组中的参数。结果IGRA的灵敏度(90.1%)高于TST(77.9%)及TB-Ab检测(7.9%);TB-Ab检测的特异度(98.6%)高于IGRA(91.7%)及TST(83.5%)。IGRA与临床诊断结果具有较高的一致性,其次为TST、TB-Ab检测(Kappa值分别为0.800、0.598、0.087)。IGRA准确度最高,其次为TST、TB-Ab检测,AUC分别为0.910、0.807及0.533。4个年龄组间IGRA(Kappa值分别为0.784、0.867、0.744、0.770)与临床诊断结果一致性均高于TST(Kappa值分别为0.459、0.548、0.736、0.567)。6~<10岁组IGRA结果与临床诊断结果比较,差异有统计学意义(P<0.05);0~<2岁组TST结果与临床诊断结果比较,差异有统计学意义(P<0.05)。结论IGRA对儿童活动性结核病的检测价值较高,TB-Ab检测诊断价值较低;联合使用IGRA及TST可以更好地提高各年龄段儿童结核病的诊断效率。

Objective To evaluate the clinical diagnosis value ofγ-interferon release assay(IGRA),tuberculin skin test(TST)and tuberculosis antibody(TB-Ab)test in children with active tuberculosis,and to analyze the performance of IGRA and TST in children in different ages.Methods A total of 367 children with suspected tuberculosis who were admitted to the hospital were retrospectively analyzed.Of these,113 cases were diagnosed as tuberculosis,254 were non-tuberculosis.Sensitivity,specificity,consistency,and area under the curve(AUC)of the three methods were statistically analyzed.Children were divided into different subgroups(0—<2 y,2—<6 y,6—<10 y,10—<15 y)according to age,then the parameters of IGRA and TST in each group were analyzed.Results The sensitivity of IGRA(90.1%)was higher than 77.9%of TST and 7.9%of TB-Ab.The specificity of TB-Ab(98.6%)was higher than 91.7%of IGRA and 83.5%of TST.IGRA had a high consistency compared with clinical diagnosis,followed by TST and the TB-Ab(Kappa values were 0.800,0.598,0.087 respectively).IGRA had the highest accuracy,followed by TST and TB-Ab,with AUC of 0.910,0.807,0.533,respectively.The consistency of IGRA with clinical diagnosis(Kappa values were 0.784,0.867,0.744,0.770)were higher than that of TST(Kappa values were 0.459,0.548,0.736,0.567)among the four age groups.There was a statistical difference between IGRA and clinical diagnosis in the 6—<10 y subgroup(P<0.05).TST had statistical difference compared with clinical diagnosis in the 0—<2 y subgroup(P<0.05).Conclusion IGRA has a high value for the detection of active tuberculosis in children,TB-Ab has a low value.A combination use of IGRA and TST should be useful to increase the diagnostic efficiency of tuberculosis in children of all ages.