γ-干扰素释放试验在抗酸杆菌涂片阴性肺结核患者诊断中的应用价值研究

Application Value ofγ-interferon Release Test in the Diagnosis of Acid-fast Bacilli Smear-negative Pulmonary Tuberculosis Patients

目的:研究γ-干扰素释放试验(IGRAs)在抗酸杆菌涂片阴性肺结核患者临床诊断中的应用价值。方法:回顾性分析2017年1月—2018年12月于广西壮族自治区南溪山医院行IGRAs与纤维支气管镜灌洗或刷检标本抗酸杆菌阴性患者320例的临床资料,根据患者是否患有肺结核分为两组,将纤维支气管镜标本涂片阴性肺结核患者178例纳入肺结核组,肺炎、肺癌等疾病患者142例纳入其他肺部疾病组。比较两组患者ICRAs与结核菌素皮肤试验(TST)检测结果,比较两种检查的诊断价值。结果:肺结核组患者IGRAs与TST阳性率均高于其他肺部疾病组,差异有统计学意义(P<0.001)。IGRAs对抗酸杆菌涂片阴性肺结核诊断的敏感度、特异度、阳性预测值及阴性预测值均高于TST,差异有统计学意义(P<0.05)。结论:抗酸杆菌涂片阴性肺结核患者IGRAs与TST阳性检出率均高于其他肺部疾病患者,但IGRAs具有更高敏感度、特异度、阳性预测值与阴性预测值,诊断价值较高。

Objective:To study the value ofγ-interferon release assay(IGRAs)in the clinical diagnosis of acid-fast bacilli smearnegative pulmonary tuberculosis.Methods:Clinical data of three hundred and twenty patients who underwent IGRAs and bronchofiberscope lavage or brush examination of acid-fast bacilli negative specimens in Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2017 to December 2018 were retrospectively analyzed.Divide into two groups occording to whether they patients has tuberculosiso or not,one hundred and seventy-eight patients with smear-negative pulmonary tuberculosis were included in the pulmonary tuberculosis group,and one hundred and forty-two patients with pneumonia,lung cancer and other diseases were included in other pulmonary diseases group.The results of ICRAs and tuberculin skin test(TST)were compared between the two groups,and the diagnostic value of the two tests was compared.Results:The positive rates of IGRAs and TST in pulmonary tuberculosis group were higher than those in other pulmonary disease groups,and the difference was statistically significant(P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of IGRAs in the diagnosis of acid-fast bacilli smear-negative pulmonary tuberculosis were higher than those of TST,and the differences were statistically significant(P<0.05).Conclusion:The positive rates of IGRAs and TST in patients with acid-fast bacilli smear-negative pulmonary tuberculosis were higher than those in patients with other pulmonary diseases,but IGRAs had higher sensitivity,specificity,positive predictive value and negative predictive value,and had higher diagnostic value.