Diagnosis value of γ-interferon release assay for sputum smear-negative pulmonarytuberculosis
-
摘要: 目的: 探讨全血γ-干扰素释放试验(IGRA)在痰涂片阴性肺结核(PTB)快速诊断中的应用价值。方法: 选择可疑PTB患者,均进行IGRA、结核菌素试验(TST)、胸部X线片和高分辨率CT(HRCT)检查,根据最终临床诊断分为PTB组和非PTB组,比较各检测手段单独和联合的诊断效能。结果: 共133例患者纳入分析,其中确诊PTB 54例,非PTB 79例,2组首诊症状组间比较差异有统计学意义(P<0.05),PTB组咳痰低于非PTB组,而胸痛、体重下降PTB组高于非PTB组;IGRA敏感度和阴性预测值均高于其他检查方法(P<0.05),特异度、阳性预测值和准确率各检测手段均差异无统计学意义(P<0.05);IGRA与TST、CT联合诊断时敏感度、阳性预测值、阴性预测值和准确率无明显增加,但特异度分别从62.4%下降到36.3%和46.7%(P<0.05);IGRA与TST、CT三者联合检测时,特异度从62.4%下降到27.1%(P<0.05)。结论: IGRA对诊断痰涂片阴性的PTB患者敏感度和阴性预测值均高于其他诊断方法,但与其他方法联合不能提高诊断效能。
-
Key words:
- lung tuberculosis /
- diagnostic accuracy /
- γ-interferon release assays
-
-
[1] 陈芳,魏毅,陈彬,等.干扰素体外释放酶联免疫法在痰涂片和痰培养均阴性肺结核诊断中的应用[J].中国卫生检验杂志,2014,24(7):949-953.
[2] Wu L, Hu Y, Li D, et al.Screening toll-like receptor markers to predict latent tuberculosis infection and subsequent tuberculosis disease in a Chinese population[J].BMC Med Genet, 2015, 16:19.
[3] 李红,唐神结,史祥,等.全血γ-干扰素释放试验对涂阴肺结核诊断价值的研究[J].中华临床医师杂志(电子版),2012,6(16):4894-4897.
[4] Park H, Shin JA, Kim HJ, et al. Whole blood interferon-γ release assay is insufficient for the diagnosis of sputum smear negative pulmonary tuberculosis[J].Yonsei Med J,2014, 55:725-731.
[5] 王安龙,袁杭. HRCT对涂阴活动性肺结核的诊断价值[J].浙江中西医结合杂志,2014,24(11):998-1000.
[6] Ebrahimzadeh A, Mohammadifard M, Naseh G. Comparison of chest x-ray findings of smear positive and smear negative patients with pulmonary tuberculosis[J]. Iran J Radiol, 2014, 11:e13575.
[7] 黄小林,廖新阳,曾小苑.新生儿卡介苗接种情况及护理对策[J].国际医药卫生导报,2013,19(11):1708-1710.
[8] Caliskan T, Ozkisa T, Aribal S, et al. High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status[J].J Thorac Dis,2014, 6:706-712.
[9] Kim S, Lee H, Kim H, et al. Diagnostic performance of a cytokine and IFN-γ-induced chemokine mRNA assay after Mycobacterium tuberculosis-specific antigen stimulation in whole blood from infected individuals[J].J Mol Diagn, 2015, 17:90-99.
[10] Lee HM, Shin JW, Kim JY, et al. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis[J]. Respiration, 2010, 79:454-460.
[11] Samb B, Henzel D, Daley CL, et al. Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative[J].Int J Tuberc Lung Dis, 1997, 1:25-30.
[12] Aichelburg MC, Rieger A, Breitenecker F, et al. Detection and prediction of active tuberculosis disease by a whole-blood interferon-gamma release assay in HIV-1-infected individuals[J]. Clin Infect Dis,2009,48:954-962.
[13] Jang JY, Park IW, Choi BW, et al. The Usefulness of the Tuberculosis Skin Test and the Interferon-gamma Release Assay in the Diagnosis of Latent Tuberculosis Infection in South Korea[J].Osong Public Health Res Perspect, 2014, 5(Suppl):S18-23.
[14] Erkens CG, Dinmohamed AG, Kamphorst M, et al. Added value of interferon-gamma release assays in screening for tuberculous infection in the Netherlands[J]. Int J Tuberc Lung Dis, 2014, 18:413-420.
[15] Roh IS, Cho S, Eum SY, et al. Kinetics of IFN-gamma and TNF-alpha gene expression and their relationship with disease progression after infection with Mycobacterium tuberculosis in guinea pigs[J]. Yonsei Med J, 2013, 54:707-714.
-
计量
- 文章访问数: 200
- PDF下载数: 160
- 施引文献: 0
下载: