γ-干扰素释放试验联合血小板及部分炎症指标检测在鉴别活动性结核中的临床应用价值

Clinical Value of Interferon-Gamma Release Assays Combined with Platelet and Some Inflammatory Index Tests in Identifying Active Tuberculosis

目的:探讨γ-干扰素释放试验(IGRAs)联合外周血中血小板(PLT)和超敏C反应蛋白(hsCRP)检测对活动性肺结核(APTB)和非活动性肺结核(IPTB)的鉴别诊断价值。方法:回顾性收集2022年1月至2024年2月杭州师范大学附属医院肺结核临床病例294例(APTB患者207例,IPTB患者87例),另收取同期本院107例健康体检人群作为对照,比较各组受试者临床信息,IGRAs及外周血中PLT、红细胞沉降率(ESR)、淋巴细胞(LY)、中性粒细胞(NEU)、hsCRP、单核细胞(MO)、中性粒细胞与淋巴细胞比值(NLR)实验室结果,并分析各个指标单独或联合检测对APTB和IPTB的鉴别性能。结果:APTB组患者IGRAs水平与IPTB组相比无显著性差异;APTB组患者PLT计数、ESR、NEU、MO、hsCRP、NLR均较IPTB组升高;LY计数较IPTB组降低,差异具有统计学意义(P Objective: To investigate the value of IFN-γ release assays (IGRAs) combined with platelet (PLT) and high-sensitivity C-reactive protein (hsCRP) in peripheral blood for the identification of active pulmonary tuberculosis (APTB) and inactive pulmonary tuberculosis (IPTB). Methods: A total of 294 clinical cases of pulmonary tuberculosis (207 patients with APTB and 87 patients with IPTB) were retrospectively collected from January 2022 to February 2024 in The Affiliated Hospital of Hangzhou Normal University, and another 107 healthy medical checkups of the population in our hospital during the same period were collected as controls, and clinical information of the subjects in each group, IGRAs, and peripheral blood of PLT, erythrocyte sedimentation rate (ESR), neutrophils (NEU) were compared, lymphocytes (LY), hsCRP, monocytes (MO), and neutrophil-to-lymphocyte ratio (NLR) laboratory results, and to analyze the discriminatory performance of each index alone or in combination for APTB and IPTB. Results: There was no significant difference in the level of IGRAs in patients in the APTB group compared with the IPTB group;PLT count, ESR, NEU, MO, hsCRP, and NLR in patients in the APTB group were higher than those in the IPTB group;and LY count was lower than those in the IPTB group, and the difference was statistically significant (P < 0.05). The IGRAs in combination with the level of hsCRP and PLT was useful in distinguishing APTB and IPTB with an AUC value of 0.905, sensitivity of 81.2% and specificity of 85.2%. Conclusion: Differences in PLT and some inflammatory markers exist between APTB and IPTB patients, and IGRAs + hsCRP + PLT detection are valuable for differential diagnosis of APTB and IPTB.