TST和IGRAs检测在肺结核和非结核性肺病鉴别诊断中的价值初探

Primary study on the values of TST and IGRAs in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous

目的探讨结核菌素皮肤试验(tuberculin skin test,TST)和γ-干扰素释放试验(interferon-γrelease assays,IGRAs)检测在肺结核和非结核性肺病鉴别诊断中的临床应用价值。方法回顾性分析2018年1月至2019年12月期间在本院就诊的603例肺结核患者[男343例,女260例,菌阳组年龄(52±20)岁,菌阴组年龄(48±20)岁]及242例非结核性肺病患者[男116例,女126例,年龄(40±16)岁]的IGRAs(T-SPOT.TB方法)和TST检测结果,应用疾病诊断性试验评价方法对IGRAs、TST单独及其8种联合检测结果的临床意义进行分析。结果在肺结核与非结核性肺病的鉴别诊断中,TST、IGRAs的敏感度分别为96.85%(584/603)、88.89%(536/603),特异度分别为7.85%(19/242)、83.06%(201/242)。就试验阳性结果而言,在“TST(1+)以上”“TST(2+)以上”“TST(3+)以上”“TST(4+)”“IGRAs(+)”5种独立试验、“TST(1+)以上/IGRAs(+)”“TST(2+)以上/IGRAs(+)”“TST(3+)以上/IGRAs(+)”“TST(4+)/IGRAs(+)”4种平行试验以及“TST(1+)以上+IGRAs(+)”“TST(2+)以上+IGRAs(+)”“TST(3+)以上+IGRAs(+)”“TST(4+)+IGRAs(+)”4种序列试验中,IGRAs(+)诊断性能最佳,其诊断敏感度、特异度、准确度、比值比(OR)、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为88.89%(536/603)、83.06%(201/242)、87.22%(737/845)、39.22、92.89%(536/577)、75.00%(201/268)、5.25和0.13。结论IGRAs作为结核潜伏感染试验,在肺结核与非结核性肺病的鉴别诊断中具有良好的辅助诊断价值。

Objective To explore the clinical application values of tuberculin skin test(TST)and interferon-γrelease assays(IGRAs)in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.Methods The data of IGRAs(T-SPOT.TB method)and TST test results of 603 patients with pulmonary tuberculosis[343 males and 260 females;the age of the bacteria positive group was(52±20)years old,and that of the bacteria negative group was(48±20)years old]and 242 patients with pulmonary diseases other than tuberculous[116 males and 126 females,with the age of(40±16)years old]who came to our hospital from January 2018 to December 2019 were collected.And the clinical significance of IGRAs,TST alone,and their 8 combined test models results were analyzed with the diagnostic test evaluation method.Results In the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous,the sensitivities of TST and IGRAs were 96.85%(584/603)and 88.89%(536/603),and the specificity were 7.85%(19/242)and 83.06%(201/242),respectively.In terms of positive test results,among 13 test models,which included 5 independent tests[TST(1+)above,TST(2+)above,TST(3+)above,TST(4+),and IGRAs(+)],4 types of parallel tests[TST(1+)above/IGRAs(+),TST(2+)above/IGRAs(+),TST(3+)above/IGRAs(+),and TST(4+)/IGRAs(+)],and 4 types of serial tests[TST(1+)above+IGRAs(+),TST(2+)above+IGRAs(+),TST(3+)above+IGRAs(+),and TST(4+)+IGRAs(+)],IGRAs(+)test model presented the best diagnostic performance,and its diagnostic sensitivity,specificity,accuracy,odds ratio(OR),positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio were 88.89%(536/603),83.06%(201/242),87.22%(737/845),39.22,92.89%(536/577),75.00%(201/268),5.25,and 0.13,respectively.Conclusion As a latent tuberculosis infection test,IGRAs have good auxiliary diagnostic values in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.