γ-干扰素释放试验对痰菌阴性肺结核患者预后的判断及γ-干扰素释放试验检测结果假阳性的危险因素分析

Prognosis of IGRA in patients with sputum-negative pulmonary tuberculosis and risk factors for false positive results of IGRA

目的分析γ-干扰素释放试验(IGRA)对痰菌阴性肺结核患者预后的判断及IGRA检测结果假阳性的危险因素。方法前瞻性选取2019年12月至2020年12月我院收治的90例痰菌阴性肺结核患者的临床资料作为研究组,另选取同期在我院进行体检的90名健康者的肝素钠抗凝全血作为对照组,采用IGRA试剂盒对血浆γ-干扰素含量进行检测,计算IGRA诊断的敏感度、特异度、阳性预测值、阴性预测值并分析假阳性的独立危险因素。结果通过Logistic回归分析可知,IGRA阳性、C反应蛋白和红细胞沉降率升高是患者存活的不良因素,而抗结核治疗、血清前白蛋白升高是患者存活的有利因素(P<0.05);研究组IGRA检测痰肺结核的敏感度、特异度、阳性预测值、阴性预测值均接近于对照组(P>0.05);性别、年龄、<40岁以及疾病诊断等均是IGRA检测痰菌阴性肺结核患者的影响因素(P<0.05);≥40岁以及疾病诊断为IGRA检测痰菌阴性肺结核患者的假阳性危险因素(P<0.05)。结论在痰菌阴性肺结核患者检测过程中,IGRA的检测结果较为理想,其敏感度、特异度较显著,预测能力较好,值得被推广。

Objective To determine the prognosis of interferon-gamma release assays(IGRA)in patients with sputum-negative pulmonary tuberculosis and the risk factors for false positive results of IGRA.Methods The clinical data of 90 patients with sputum-negative pulmonary tuberculosis admitted to our hospital between De-cember 2019 and December 2020 were prospectively included as the study group.The heparin sodium anticoag-ulant whole blood of a contemporary cohort of 90 healthy subjects was included as the control group.IGRA kit was used to examine the level of plasma interferon-gamma,and ELISA kit was used to detect tuberculosis anti-body(TBAb)to evaluate the prognosis of IGRA for patients.The sensitivity,specificity,positive predictive value,and negative predictive value of IGRA diagnosis were calculated,and the risk factors of false positives were deter-mined.Results The analysis of the Logistic model showed that positive IGRA and increased C-reactive protein and erythrocyte sedimentation rate were adverse factors for patient survival,while anti-tuberculosis treatment and increased serum prealbumin were favorable factors for patient survival(P<0.05).The sensitivity,specificity,posi-tive predictive value,and negative predictive value of IGRA in the study group for detecting sputum-negative pul-monary tuberculosis were close to those in the control group(P>0.05).The results showed that gender,age<40 years old,and disease diagnosis were all potential factors for IGRA to determine sputum-negative pulmonary tu-berculosis(P<0.05),≥40 years old and disease diagnosis were false-positive risk factors for sputum-negative pul-monary tuberculosis determined by IGRA(P<0.05).Conclusion In detection of sputum-negative pulmonary tuber-culosis,the results of IGRA are relatively satisfactory,with significant sensitivity and specificity,and good pre-dictive ability,and there for IGRA is worthwhile of widespread use.