多层螺旋CT与γ干扰素释放试验诊断活动性肺结核的效能比较

Performance of Multi-Slice Spiral CT and γ-Interferon Release Assays in Diagnosing Active Pulmonary Tuberculosis:A Comparative Study

目的 比较多层螺旋CT(MSCT)与γ干扰素释放试验(IGRAs)辅助诊断活动性肺结核的效能。资料与方法 回顾性收集2017年5月—2019年8月于广州市胸科医院就诊的临床症状疑似活动性肺结核的患者75例,经组织活检病理检查确诊的活动性肺结核患者40例作为研究组,显微支气管检查及痰结核菌涂片检查排除存在结核分枝杆菌感染的其他肺部疾病患者35例作为对照组。所有患者均行MSCT及IGRAs检测,比较MSCT、IGRAs与两者联合检测活动性肺结核的敏感度、准确度及特异度。结果 研究组中,MSCT正确诊断32例(80.0%),误诊8例(20.0%);IGRAs正确诊断36例(90.0%),漏诊/误诊4例(10.0%)。对照组中,MSCT正确诊断31例(88.6%),误诊4例(11.4%);IGRAs正确诊断34例(97.1%),误诊1例(2.9%)。MSCT诊断活动性肺结核的敏感度、准确度及特异度分别为80.0%、84.0%、88.6%,IGRAs分别为90.0%、93.3%、97.1%,两者联合检测分别为97.5%、98.7%、100.0%。结论 IGRAs辅助诊断活动性肺结核的效能优于MSCT,两者联合可以互为补充,提高诊断效能。

Purpose To compare the diagnostic performance of multi-slice spiral CT(MSCT) and γ-interferon release assays(IGRAs in patient with active pulmonary tuberculosis. Materials and Methods A total of 75 patients with clinical symptoms who were suspected of active pulmonary tuberculosis were retrospectively selected from May 2017 to August 2019 in Guangzhou Chest Hospital. Forty patients with active pulmonary tuberculosis diagnosed by pathological examination of tissue biopsy were collected and considered as the study group, and 35 patients with other lung diseases infected by mycobacteria diagnosed by microbronchial examination and sputum tuberculosis smear examination ruled out the presence of tuberculosis were collected and considered as the control group. All patients underwent both MSCT and IGRAs. The sensitivity, accuracy and specificity of MSCT, IGRAs and MSCT combined with IGRAs in diagnosis of active pulmonary tuberculosis were further analyzed and compared. Results In the study group, 32 cases(80.0%) were correctly diagnosed by MSCT, 8 cases(20.0%) were misdiagnosed, 36 cases(90.0%) were correctly diagnosed by IGRAs and 4 cases(10.0%) were missed/misdiagnosed. In the control group, 31 cases(88.6%) were correctly diagnosed by MSCT, 4 cases(11.4%) were misdiagnosed, 34 cases(97.1%) were correctly diagnosed by IGRAs, 1 case(2.9%) was misdiagnosed. The sensitivity, accuracy and specificity of MSCT in diagnosing active pulmonary tuberculosis were 80.0%, 84.0% and 88.6%, respectively;and IGRAs were 90.0%,93.3% and 97.1%, respectively;and the MSCT combined with IGRAs were 97.5%, 98.7% and 100.0%, respectively. Conclusion The diagnostic performance of IGRAs in active pulmonary tuberculosis is better than that of MSCT. The combination between IGRAs and MSCT could complement each other and improve the diagnostic performance.