结核分枝杆菌γ-干扰素体外释放试验(TB-IGRA)对结核性胸腔积液的诊断价值

摘要

Objective To investigate the application significance of mycobacterium tuberculosis (MTB) IFN-γ release assay (TB-IGRA) in the rapid diagnosis for suspected MTB infected patients with pleural effusion. Methods 138 suspected MTB infected patients with pleural effusion were enrolled. TB-IGRA was used to determine the level of IFN-γ of peripheral blood lymphocyte. The MTB DNA method was used to detect MTB in pleural effusion, meanwhile serum anti-MTB antiboby was detected by immunogold filtration assay. Results 48 cases of 138 suspected were diagnosed as tuberculosis by sputum, pleural effusion and ascites smear test, sputum, pleural effusion and ascites MTB culture, tuberculin skin test, MTB DNA method and anti-MTB antibody test, and positive rate was 34.8％. Positive rates of TB-IGRA, MTB DNA method and anti-MTB antibody test in the 138 patients with pleural effusion was 32.6％, 13.8％, and 10.1％ respectively. TB-IGRA had the consistency rate of 93.5％, while the consistency rates of MTB DNA method and anti-MTB antibody test were 68.8％ and 68.1％respectively. Positive rate and consistency rate of TB-IGRA were significantly higher than those of the others (P<0.01). The positive and negative predictive values of TB-IGRA in suspected MTB infected patients with pleural effusion were 93.3％ and 93.5％ respectively. Conclusion TB-IGRA is fast with hypersensitivity and high specificity to diagnose the suspected MTB infected patients with pleural effusion. TB-IGRA is better than MTB DNA method and anti-MTB antibody test. TB-IGRA can become a new diagnostic method to be applied in the diagnosis of MTB infection.%目的 探讨结核分枝杆菌(MTB)γ-干扰素体外释放试验(TB-IGRA)在疑似MTB感染伴胸腔积液患者快速诊断中的应用价值.方法 对2013年4月—2015年2月138例疑似MTB感染伴胸腔积液患者,应用TB-IGRA定量检测外周血淋巴细胞分泌γ-干扰素的水平,MTB DNA法检测胸腔积液中的MTB,免疫金标法检测血清MTB抗体,并进行统计学分析.结果 138例疑似患者经过痰和胸腹水抗酸染色镜检,痰液和胸腹水MTB培养,结核菌素皮肤试验,MTB DNA和MTB抗体等试验确诊结核病患者48例,阳性检出率34.8％,TB-IGRA、MTB DNA和血清MTB抗体的阳性检出率分别为32.6％、13.8％、10.1％,准确率分别为93.5％、68.8％、68.1％.TB-IGRA的阳性检出率和准确率均显著高于其他2种方法,差异有统计学意义(P<0.01).TB-IGRA对疑似MTB感染的胸腔积液患者诊断的阳性预测值为93.3％,阴性预测值为93.5％.结论 TB-IGRA诊断疑似MTB感染伴胸腔积液患者具有快速,高敏感性、高特异性的特点,优于MTB DNA和血清MTB抗体试验,可以作为一种人体MTB感染的诊断新技术.