摘要
目的 探讨γ-干扰素释放试验(interferon-gamma release assay,IGRA)在不同类型肺结核中的应用价值.方法 收集2015-2016年于我院及重庆市人民医院1 449例住院患者,分析和比较IGRA在肺结核、活动性肺结核、陈旧性肺结核、特殊人群肺结核、其他肺病中的灵敏度.结果 IGRA对肺结核的灵敏度为84.4％,与其他肺病组比较差异有统计学意义(P＜0.05);其对活动性肺结核灵敏度(85.6％)与陈旧性肺结核(79.7％)比较差异无统计学意义(P＞0.05);菌阳肺结核、菌阴肺结核的灵敏度分别为85.1％、86.6％,两组比较差异无统计学意义(P＞0.05);其中痰涂片阳性但IGRA阴性者25例,菌种鉴定为结核分枝杆菌20例(80％),非结核分枝杆菌5例(20％);4例孕妇合并肺结核IGRA均阳性(100％).结论 ①单用IGRA不能鉴别陈旧性肺结核与活动性肺结核,应联合其他检测手段;②若菌阳但IGRA阴性的肺疾病患者要考虑病原菌为非结核分枝杆菌的可能,应进一步行分枝杆菌菌种鉴定;③既往无结核病史的特殊人群(如孕妇)IGRA阳性有利于辅助诊断活动性结核病.
Abstract
Objective To investigate the diagnostic value of interferon-gamma release assay (IGRA) in different types of pulmonary tuberculosis (TB).Methods IGRA was performed in 1 449 hospitalized patients in our hospital and the People's Hospital of Chongqing from January 1,2015 to December 31,2016.The sensitivity of IGRA for diagnosis of TB was evaluated,specifically in patients with TB,active TB,old TB,and other pulmonary diseases,as well as TB in special population.Restlts The sensitivity of IGRA in patients with TB (84.4％) was significantly different from the patients with other pulmonary diseases (P ＜ 0.05);however,no significant difference was seen in the sensitivity between active TB (85.6％) and old TB (79.7％,P ＞ 0.05).In sputum smear-positive and smear-negative TBs,the sensitivity of IGRA was respective 85.1％ and 86.6％,which was not statistically different (P ＞ 0.05).There were 25 cases tested as sputum smear-positive but IGRA-negative.Among them,80％ (20 cases) were Mycobacterium tuberculosis and 20％ (5 cases) were non-tuberculosis mycobacterium.Four cases of pregnant women with TB were all IGRA-positive (100％).Conclusion Our results showed that:① active TB and old TB cannot be differentially diagnosed by IGRA alone,Other examinations should be combined to improve the diagnosis accuracy;②Patient with sputum smear-positive but IGRA-negative may possibly be infected by nontuberculosis mycobacterium.Mycobacterium strains should be further identified;③In special population such as pregnant women who had no TB history,IGRA-positive result is helpful for the diagnosis of active TB.
基金项目
重庆市卫生计生委医学科研计划重点项目(2015ZDXM013)
国家科技期刊平台
NSTL
维普
万方数据