目的 评价结核分枝杆菌(Mycobacterium tuberculosis,MTB)特异性细胞因子干扰素-γ(interferon-γ,IFN-γ)和白细胞介素-2(interleukin-2,IL-2)双因子联合检测在活动性肺结核(active tuberculosis)中的诊断效能.方法 收集西安市胸科医院2023年6-12月住院患者292例,根据临床诊断分为活动性肺结核组160例(男性81例,女性79例),非结核性肺部疾病组132例(男性72例,女性60例).对所纳入的292例患者进行MTB特异性双因子(IFN-γ、IL-2)检测、分枝杆菌培养(BACTEC MGIT 960液体培养)、实时荧光定量反转录PCR(quantitative reverse transcriptase-mediated PCR,qRT-PCR)检测、结核分枝杆菌RNA恒温扩增检测(simultaneous amplification and testing for Mycobacterium tubercu-losis,SAT-TB)和痰涂片检查,评价MTB特异性双因子的诊断效能,并比较双因子血清学方法、细菌学方法(分枝杆菌培养、痰涂片检查)和分子生物学方法(qRT-PCR、SAT-TB)对诊断活动性肺结核的差异.结果 以临床诊断为标准,MTB特异性双因子检测的灵敏度、特异度、阳性预测值、阴性预测值和约登指数分别为:80.63%、80.30%、83.23%、77.37%和0.61.与qRT-PCR、SAT-RNA、痰涂片检查和分枝杆菌培养相比,双因子检测的灵敏度(χ2=66.117、96.008、103.789、76.650,均P<0.001)、约登指数和Kappa值均高于其他4种检测方法,特异度差异无统计学意义(χ2=1.918、1.865、0.000、0.139,均P>0.05).方法学比较中,血清学组的阳性率为80.63%,高于细菌学组(31.20%)和分子生物学组(38.46%),差异均具有统计学意义(χ2=56.101,74.645;均P<0.001).结论 MTB特异性双因子检测方法对活动性肺结核的诊断具有较高的灵敏度,可作为诊断活动性肺结核的免疫学标志物,有助于提高诊断的准确率.
Application of combined detection of Mycobacterium tuberculosis-specific cytokines IFN-γ and IL-2 in the diagnosis of active tuberculosis
Objective To evaluate the diagnostic efficacy of combined detection of Mycobacterium tuberculosis-specific cytokines interferon-γ(IFN-γ)and interleukin-2(IL-2)in active tuberculosis.Methods Data were collected from 292 inpatients at Xi'an Chest Hospital from June to December 2023,categorized into an active tuberculosis group with 160 cases(81 males and 79 females),and a non-tuberculosis group with 132 cases(72 males and 60 females).MTB-specific dual factor(IFN-γ and IL-2)detection,mycobacterial culture(BACTEC MGIT 960 liquid culture),real-time fluorescence quantitative reverse transcriptase-mediated PCR(qRT-PCR),simultaneous amplification and testing for Mycobacterium tuberculosis(SAT-TB),and sputum smear microscopy were performed on these patients.The diagnostic efficacy of MTB-specific double factorwas assessed,and differences in diagnosing active pulmonary tuberculosis using serological methods,bacteriological methods(mycobacterial culture,sputum smear microscopy),and molecular biological methods(qRT-PCR,SAT-TB)were compared.Results Using clinical diagnosis as a standard,the sensitivity,specificity,positive predictive value,negative predictive value,and Youden's index of MTB-specific dual factor detection were 80.63%,80.30%,83.23%,77.37%,and 0.61,respectively.Compared with qRT-PCR,SAT-RNA,sputum smear microscopy,and mycobacterium culture,the sensitivity(χ2=66.117,96.008,103.789,76.650;all P<0.001),Youden's index,and Kappa values of specific dual factor detection were higher than those of the other four detection methods,with no significant difference in specificity(χ2=1.918,1.865,0.000,0.139,all P>0.05).In methodological comparisons,the serological group had a positive rate of 80.63%,higher than the bacteriological group(31.20%)and the molecular biological group(38.46%),with statistically significant differences(χ2=56.101,74.645;both P<0.001).Conclusions The MTB-specific dual factor detection has a high sensitivity in the diagnosis of active tuberculosis and can be used as an immunological marker in the diagnosis of active tuberculosis,contributing to improving the accuracy of diagnosis.
万方数据
维普
