QuantiFERON-TB GOLD对活动性结核病的诊断价值及影响因素分析

Analysis of Diagnostic Value and Influencing Factors of QuantiFERON-TB GOLD in Active Tuberculosis

目的:探讨γ干扰素释放实验QuantiFERON-TB GOLD(QFT-G)对活动性结核病的诊断价值及影响因素。方法:回顾性分析2018年7月—2019年7月在川北医学院附属医院行QFT-G检测的住院患者的资料,分析QFT-G在活动性结核病诊断中的敏感性、特异性及影响因素。结果:(1)活动性结核QFT-G的敏感度、特异度、阳性预测值及阴性预测值分别为80.04%、59.30%、71.46%、81.20%。陈旧性结核QFT-G阳性率为66.39%。(2)年龄>61岁(OR=2.463,95%CI=1.026~5.917,P=0.044)、实体肿瘤合并感染(OR=2.813,95%CI=1.144~6.918,P=0.024)和风湿性疾病(OR=6.122,95%CI=2.132~17.576,P=0.001)分别是QFT-G假阴性、假阳性和不确定结果的独立影响因素。结论:(1)QFT-G敏感度较好,但特异性不理想,对于结核的排除价值更高。(2)QFT-G不适合用于鉴别活动性及陈旧性结核。(3)QFT-G用于年龄>61岁、实体肿瘤合并感染、风湿性疾病患者诊断结核时需注意假阴性、假阳性和不确定结果。

Objective:To investigate the diagnostic value and influencing factors of QuantiFERON-TB GOLD(QFT-G)of interferon-γrelease assay for active tuberculosis.Methods:The data of inpatients who underwent QFT-G detection in the Affiliated Hospital of North Sichuan Medical College from July 2018 to July 2019 were retrospectively analyzed,and the sensitivity,specificity and influencing factors of QFT-G in the diagnosis of active tuberculosis were investigated.Results:(1)The sensitivity,specificity,positive predictive value and negative predictive value of QFT-G for active tuberculosis were 80.04%,59.30%,71.46% and 81.20%,respectively.The positive rate of QFT-G in old tuberculosis was 66.39%.(2)Age>61 years(OR=2.463,95%CI=1.026~5.917,P=0.044),solid tumor with infection(OR=2.813,95%CI=1.144~6.918,P=0.024)and rheumatic diseases(OR=6.122,95%CI=2.132~17.576,P=0.001)were independent influencing factors of QFT-G false negative,false positive and uncertain results,respectively.Conclusion:(1)The sensitivity of QFT-G is good,but the specificity is not ideal,and it has a higher value for the exclusion of tuberculosis.(2)QFT-G is not suitable for identifying active and old tuberculosis.(3)When QFT-G is used for the diagnosis of tuberculosis in patients with age>61 years,solid tumor co-infection,and rheumatic diseases,attention should be paid to false negative,false positive and uncertain results,respectively.