目的 评价外周血结核分枝杆菌γ-干扰素体外释放试验(TB-IGRA)对结核性脑膜炎早期辅助诊断的价值.方法 收集2015年1-12月四川大学华西医院住院治疗的56例结核性脑膜炎患者(实验组)及56例非结核性脑膜炎患者(对照组)的TB-IGRA、脑脊液结核分枝杆菌培养、脑脊液TB-DNA的检查结果,计算各诊断方法的灵敏度和特异度.结果 TB-IGRA、脑脊液培养、脑脊液TB-DNA诊断结核性脑膜炎的灵敏度分别为87.5％(49/56)、19.6％(11/56)、60.7％(34/56),特异度分别为89.3％(50/56)、100.0％(56/56)、76.8％(43/56).TB-IGRA诊断结核脑膜炎的灵敏度高于脑脊液TB-DNA检查和脑脊液结核分枝杆菌培养,且TB-IGRA特异度高于脑脊液TB-DNA(89.3％>76.8％),三者两两相比,差异均具有统计学意义(均P<0.01).其中脑脊液培养确诊的11例病例中,有10例TB-IGRA阳性,阳性率为90.9％(10/11);45例临床诊断+抗结核治疗有效的病例中,TB-IGRA阳性39例,阳性率为86.7％(39/45).结论 TB-IGRA协助结核性脑膜炎患者的早期诊断具有高灵敏度和特异度,其检查方便、快速、有效,值得临床推广.%Objective To evaluate the value of peripheral blood Mycobacterium tuberculosis interferon-γ release assay(TB-IGRA )in early adjuvant diagnosis of tuberculous meningitis(TBM).Methods 56 patients with TBM (trial group) and 56 patients with non-TB meningitis (control group) admitted to West China Hospital of Sichuan University in January-December 2015 were analyzed, results of TB-IGRA, cerebrospinal fluid(CSF) Mycobacterium tuberculosis(MT) culture, and CSF TB-DNA testing of two groups of patients were analyzed, the sensitivity and specificity of each diagnostic method were calculated.Results The sensitivity of TB-IGRA, CSF MT culture, and CSF TB-DNA for diagnosis of TBM were 87.5％(49/56), 19.6％(11/56), and 60.7％(34/56) respectively,specificity were 89.3％(50/56), 100.0％(56/56), and 76.8％(43/56)respectively.The sensitivity of TB-IGRA for diagnosing TBM was higher than that of CSF TB-DNA and CSF MT culture, specificity of TB-IGRA was higher than that of CSF TB-DNA(89.3％>76.8％), pairwise comparison showed a significant difference(all P<0.01).Among 11 cases confirmed by CSF culture, 10 (90.9％[10/11])were positive for TB-IGRA;among 45 cases with clinical diagnosis and effective anti-tuberculosis treatment, 39 (86.7％[39/45])were positive for TB-IGRA.Conclusion TB-IGRA is highly sensitive and specific in the early adjuvant diagnosis of TBM, it is convenient, rapid, effective, and worthy to be popularized in clinical practice.
展开▼
