两种常用免疫学指标对结核病的辅助诊断价值

The auxiliary diagnostic value of two common immunological indicators for tuberculosis

目的探索两种常用免疫学指标-结核菌素试验(purified protein derivative skin test,PPD皮试)与结核分枝杆菌γ-干扰素释放试验(tuberculosis-interferon gamma release assay,TB-IGRA)对结核病的辅助诊断价值。方法收集2017年1月-2021年1月于我中心门诊部就诊的疑似结核病患者资料,共171例,所有病例均行PPD皮试和外周血TB-IGRA。将病例分为结核病组(TB组)和非结核病组(非TB组)。TB组共98例,非TB组共73例。比较两组病例PPD皮试、TB-IGRA对结核病诊断的准确度、敏感度、特异度。结果TB-IGRA对结核病诊断的准确度、敏感度和特异度分别为94.2%、93.9%和90.4%,PPD皮试对结核病诊断的准确度、敏感度和特异度分别为77.2%、84.7%和76.7%。TB-IGRA的准确度和特异度与PPD皮试比较差异有统计学意义(分别为χ^(2)=20.034,P<0.05和χ^(2)=5.176,P<0.05);TB-IGRA的敏感度高于PPD皮试,但两者比较差异无统计学意义(χ^(2)=0.948,P>0.05)。2组间TB-IGRA结果、PPD皮试结果比较差异均具有统计学意义(分别为χ^(2)=132.77,P<0.01和χ^(2)=47.9635,P<0.01)。结论TB-IGRA和PPD皮试均具有良好的结核病辅助诊断价值;TB-IGRA的引进大大提高了诊断试验的准确度和特异度,但仍需要进一步探索其诊断标准以更好地为临床使用。

Objective To explore the auxiliary diagnosis value of two commonly used immunological indicators for tuberculosis,purified protein derivative skin test(PPD test)and tuberculosis-interferon gamma release assay(TB-IGRA).Methods A total of 171 cases of suspected tuberculosis patients who were treated in the outpatient department of our center from January 2017 to January 2021 were collected.All cases underwent PPD test and peripheral blood TB-IGRA.The cases were divided into tuberculosis groups(TB group)and non-tuberculosis group(non-TB group).There were 98 cases in the TB group and 73 cases in the non-TB group.The accuracy,sensitivity,and specificity of PPD test and TB-IGRA for tuberculosis diagnosis were compared between the two groups.Results The accuracy,sensitivity,and specificity of TB-IGRA for tuberculosis diagnosis were 94.2%,93.9%and 90.4%respectively,which of PPD test for tuberculosis diagnosis were 77.2%,84.7%and 76.7%respectively.The accuracy and specificity of TB-IGRA were statistically different from those of PPD test(χ^(2)=20.034,P<0.05 andχ^(2)=5.176,P<0.05,respectively).The sensitivity of TB-IGRA was higher than that of PPD test,but the difference was not statistically significant(χ^(2)=0.948,P>0.05).The differences of TB-IGRA and PPD test results between the two groups were statistically significant(χ^(2)=132.77,P<0.01 andχ^(2)=47.9635,P<0.01).Conclusion Both TB-IGRA and PPD test had good auxiliary diagnostic value for tuberculosis;the introduction of TB-IGRA had greatly improved the accuracy and specificity of the diagnostic test,but it is still necessary to further explore its diagnostic criteria to better serve the clinical use.