结核病γ-干扰素释放试验假阴性的影响因素分析

Analysis of influencing factors in false negative results of interferon gamma release assay in pulmonary tuberculosis

目的探究γ-干扰素释放试验(IGRA)假阴性结果的影响因素,为临床诊断结核感染提供参考。方法收集广州医科大学附属第一医院2022年1月1日至2023年11月30日期间符合入组要求的患者资料,分为IGRA假阴性组与阳性组,对多项指标包括年龄、性别、单核细胞计数、淋巴细胞计数、淋巴细胞比率、总蛋白含量、白蛋白含量、合并症、T淋巴细胞亚群及绝对计数进行统计学分析。结果IGRA假阴性组与阳性组在年龄、性别、单核细胞计数、总蛋白含量和合并症比较,差异均无统计学意义(均P>0.05);在淋巴细胞计数、淋巴细胞比率、白蛋白含量比较,差异均有统计学意义(均P<0.05)。假阴性组的淋巴细胞计数、淋巴细胞比率、白蛋白含量低于阳性组,两组患者在合并糖尿病、高血压、病毒性肝炎上差异均无统计学意义(均P>0.05)。两组患者的T淋巴细胞绝对计数比较差异有统计学意义(P<0.05),T辅助淋巴细胞绝对计数和T抑制淋巴细胞绝对计数两组间差异均无统计学意义(均P>0.05)。χ^(2)检验显示各淋巴细胞计数分段与IGRA结果相关(P<0.05);多因素Logistic回归分析显示,淋巴细胞计数、淋巴细胞比率、白蛋白含量是IGRA假阴性的独立影响因素。结论淋巴细胞计数、淋巴细胞比率、白蛋白含量可能是IGRA假阴性结果的影响因素,对于疑似结核病患者,若出现IGRA阴性结果,需结合临床进行综合判断。

Objective To investigate factors contributing to false-negative results in the interferon gamma release assay(IGRA)and provide insights for the clinical diagnosis of tuberculosis infection.Methods Collect patient data from the First Affiliated Hospital of Guangzhou Medical University from January 1,2022 to November 30,2023,who meet the enrollment requirements,and divide them into IGRA false negative group and positive group.Various indicators,including age,gender,monocyte counts,lymphocyte counts,lymphocyte ratio,total protein and albumin levels,comorbidities,T lymphocyte subsets and absolute counts,were statistically analyzed.Results No significant differences(all P>0.05)were observed between the IGRA false-negative and positive groups concerning age,gender,monocyte counts,total protein levels,and comorbidities.However,statistically significant differences(all P<0.05)were noted in lymphocyte counts and ratio,albumin levels.The false-negative group had lower lymphocyte counts,lymphocyte ratio and albumin levels than the positive group.No significant difference between the two groups in the combination of diabetes,hypertension and viral hepatitis(all P>0.05).There was a significant difference in the absolute count of T lymphocyte between the two groups(P<0.05).There were no significant differences in the absolute counts of T-helper lymphocyte and T-suppressor lymphocyte between the two groups(all P>0.05).χ^(2)analysis revealed correlation between segmented lymphocyte counts and IGRA results(P<0.05).Multifactorial logistic regression analysis indicated that lymphocyte counts and ratio,albumin levels were independent influencing factors for IGRA false-negative results.Conclusions Lymphocyte counts and ratio,albumin levels may influence IGRA false-negative results.For suspected tuberculosis patients,IGRA negative results should be interpreted in conjunction with comprehensive clinical judgment.