γ-干扰素释放试验QFT-GIT检测可疑结核感染患者不确定结果的影响因素分析

Influencing factors for indeterminate test results of QuantiFERON-TB Gold In-Tube detection in patients with suspected tuberculosis infection

目的探讨可疑结核感染患者的γ-干扰素释放试验QuantiFERON-TB Gold In-Tube(QFT-GIT)不确定结果(ITRs)的影响因素。方法回顾2019年2月至2020年2月浙江大学医学院附属金华医院2473例可疑结核感染患者QFT-GIT结果,同时记录患者入院时的WBC、淋巴细胞数(L)、血清总蛋白(TP)、血清白蛋白(Alb)、ALT、AST等指标水平,比较不同性别、不同年龄组(0~5岁、6~15岁、16~30岁、31~45岁、46~60岁、61~75岁、≥76岁)ITRs发生率,分析ITRs产生的影响因素。结果采用QFT-GIT检测2473份可疑结核感染患者标本,其中ITRs为190例,确定结果(阴性或者阳性)为2283例,ITRs总发生率为7.68%,男性发生率为8.5%(124/1460),女性发生率为6.5%(66/1013),不同性别组ITRs发生率差异无统计学意义(P>0.05);0~5岁年龄组ITRs发生率最高[17.3%(18/104)],且与16~30岁组[5.6%(17/304)]、31~45岁组[4.6%(20/435)]、46~60岁组[7.4%(49/665)]、61~75岁组[7.4%(49/662)]比较差异均有统计学意义(均P<0.01),6~15岁组[10.3%(9/87)]和31~45岁组比较差异有统计学意义(P<0.05),≥76岁组[12.9%(28/216)]和16~30岁组、31~45岁组、46~60岁组、61~75岁组比较差异均有统计学意义(均P<0.05),ITRs组和确定结果组性别和年龄差异均无统计学意义(P>0.05)。ITRs组TP、Alb以及L水平明显低于确定结果组(均P<0.01),ALT、AST以及WBC水平高于确定结果组(均P<0.01)。多因素logistic回归分析显示QFT-GIT ITRs发生的独立危险因素有低TP(OR=0.946,95%CI:0.936~0.956),低Alb(OR=0.901,95%CI:0.868~0.935),高ALT(OR=1.034,95%CI:1.022~1.047),高WBC(OR=1.064,95%CI:1.015~1.115),低L(OR=0.962,95%CI:0.939~0.982)。结论不同性别对QFT-GIT检测可疑结核感染ITRs发生率无明显影响,低龄(0~5岁)或者高龄(≥76岁)ITRs发生率最高,此外低TP、低Alb、低L和高ALT、高WBC是QFT-GIT检测出现ITRs的独立危险因素。

Objective To evaluate the influencing factors for indeterminate test results(ITRs)of Quanti FREON-TB Gold In-Tube Test in patients with suspected tuberculosis infection.Methods A total of 2473 patients with suspected tuberculosis were tested with QFT-GIT from February 2019 to February 2020 in Jinhua Hospital.The white blood cell counts,lymphocyte counts,total serum protein,serum albumin,ALT,AST were also tested.The incidence of the ITRs in different gender and age groups(0~5,16~30,31~45,46~60,61~75,≥years)were compared,and the influencing factors of ITR were analyzed.Results Among 2473 samples of QFT-GIT tests,190 were indeterminate results with an overall incidence rate of 7.68%,8.5%(124/1460)for males and 6.5%(66/1013)for females.There was no significant gender difference in the incidence of ITRs(P>0.05).The incidence of ITRs in age groups of 0~5,16~30,31~45,46~60,61~75 were 17.3%(18/104),5.6%(17/304),4.6%(20/435),7.4%(49/665)and 7.4%(49/662),respectively(all P<0.01).There was significant difference in ITR incidence between age group 6~15[10.3%(9/87)]and age group 31~45(P<0.05).There were significant differences in ITR between age group≥76[12.9%(28/216)]and age groups 16~30,31~45,46~60,61~75(all P<0.05).There was no significant difference in age distributions of patients between indeterminate results group and determinate results group(P>0.05).The total serum protein level,albumin level and the lymphocyte counts in patients with ITRs were significantly lower than those in patients with determinate results(P<0.01).Meanwhile,the level of ALT and AST,white blood cell counts in patients with ITR were significantly higher than those in patients with determinate results(P<0.01).Multivariate logistic regression analysis revealed that low total serum protein(OR=0.946,95%CI:0.936~0.956),low albumin(OR=0.901,95%CI:0.868~0.935),increased ALT(OR=1.034,95%CI:1.022~1.047),increased white blood cell counts(OR=1.064,95%CI:1.015~1.115),lymphocytopenia(OR=0.962,95%CI:0.939~0.982)were significant predictors of QFT-GIT indeterminate results.Conclusion There were no significant difference in gender between indeterminate results group and determinate results group.Patients aged 0~5 years and≥76 years have the highest incidence of ITRs,low total serum protein,low albumin,increased ALT,increased white blood cell counts and lymphocytopenia are the significant predictors of indeterminate results of QFT-GIT.