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中华诊断学电子杂志

中华诊断学电子杂志 ›› 2014, Vol. 02 ›› Issue (03) : 187 -190. doi: 10.3877/cma.j.issn.2095-655X.2014.03.005

所属专题： 文献；

胸腔积液诊疗专题

结核杆菌γ-干扰素体外释放试验对结核性胸腔积液的诊断价值
姜鲁宁1,†(), 刘雪青1   
  1. 1. 272029　济宁医学院附属医院呼吸科
  • 收稿日期:2014-09-14 出版日期:2014-08-26
  • 通信作者: 姜鲁宁
  • 基金资助:
    济宁市科技局项目(2013jnwk54)

The clinical value of IFN-γ release assays on the diagnosis of tuberculous pleural effusion

Luning Jiang1,†(), Xueqing Liu1   

  1. 1. Department of Pulmonary Medicine, Affiliated Hospital of Jining Medical University, Jining 272100, China
  • Received:2014-09-14 Published:2014-08-26
  • Corresponding author: Luning Jiang
  • About author:
    Corresponding author: Luning Jiang, Email:
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姜鲁宁, 刘雪青. 结核杆菌γ-干扰素体外释放试验对结核性胸腔积液的诊断价值[J]. 中华诊断学电子杂志, 2014, 02(03): 187-190.

Luning Jiang, Xueqing Liu. The clinical value of IFN-γ release assays on the diagnosis of tuberculous pleural effusion[J]. Chinese Journal of Diagnostics(Electronic Edition), 2014, 02(03): 187-190.

目的

探讨体外释放酶联免疫法检测结核杆菌γ-干扰素(TB-IGRA)对结核性胸腔积液的诊断价值。

方法

收集济宁医学院附属医院呼吸科2014年1～9月诊治的55例结核性和49例恶性胸腔积液患者的病例资料，对患者进行TB-IGRA、细菌涂片镜检、结核菌素皮试(PPD)和结核杆菌抗体等检测，并对以上诊断方法进行比较分析。同时联合检测血清癌胚抗原(CEA)及胸腔积液腺苷脱氨酶(ADA)，以评估TB-IGRA联合CEA和ADA对鉴别诊断结核性胸腔积液的意义。采用SPSS 17.0统计软件进行数据分析，阳性例数以率表示，并进行卡方检验。CEA和ADA的测定值用均数±标准差表示，显著性检验用t检验。

结果

55例结核组患者TB-IGRA阳性53例，达96.36%；49例恶性组患者TB-IGRA阳性1例，仅2.04%，两组差异有统计学意义(χ2＝88.62，P<0.05)。结核组血清CEA水平[(2.34±1.80)μg/L]显著低于恶性组[(2 358.68±1 069.40)μg/L，t＝－15.42，P<0.05]；胸腔积液ADA水平[(57.51±26.90)U/L]显著高于恶性组[(14.43±3.57)U/L，t＝11.76 ，P<0.05]。结核组中TB-IGRA、涂片镜检、PPD试验以及结核杆菌抗体的阳性率分别为96.36%、22.64%、46.67%和35.14%，TB-IGRA的阳性检测率最高(χ2＝78.60，P<0.05)；TB-IGRA对诊断结核性胸腔积液的敏感度(95.65%)、特异度(96.77%)、阳性预测值(97.78%)、阴性预测值(93.75%)及准确性(92.42%)最高。

结论

与传统的检测指标相比，TB-IGRA更具灵敏性和特异性；TB-IGRA联合CEA、ADA检测对诊断结核性胸腔积液具有极为重要的临床价值。

关键词: 干扰素γ, 结核, 胸腔积液
Objective

To evaluate the clinical significance of mycobacterium tuberculosis(MTB) related interferon-gamma(IFN-γ) in vitro by enzyme-linked immunosorbent assays for the diagnosis of tuberculous pleural effusion.

Methods

The clinical data with fifty-five cases with tuberculous and forty-nine cases with malignant pleural effusion were diagnosed and treated in Affiliated Hospital of Jining Medical University from January to September in 2014.These patients were detected by diagnostic kit for mycobacterium tuberculosis correlative IFN-γ realse assay(TB-IGRA), bacterial smear, purified protein derivative test and mycobacterium tuberculosis antibodies.Then the above diagnostic methods were compared and analyzed.Serum carcinoembryonic antigen (CEA) and pleural fluid adenosine deaminase (ADA) together were detected, and the clinical value of TB-IGRA, CEA and ADA for differential diagnosis of tuberculous pleural effusion assessed.

Results

There were fifty-three TBIGRA positive cases of fifty-five patients in the tuberculosis group and the positive rate was 96.36%.However, there was only one positive case of forty-nine patients in the malignant group and the positive rate was only 2.04%.The statistical differences were significant between two groups (χ2=88.62, P<0.05). The serum CEA levels in the tuberculosis group[(2.34±1.80)μg/L] were significantly lower than the malignant group[(2358.68±1069.40)μg/L, t=-15.42, P<0.05]. The pleural fluid ADA levels [(57.51±26.90)U/L, t=11.76, P<0.05] were significantly higher than the malignant group[(14.43±3.57)U/L]. The positive rate of TB-IGRA, bacterial smear, purified protein derivative test and mycobacterium tuberculosis antibodies were 96.3%, 22.64%, 46.67% and 35.14%.The positive detection rate of TB-IGRA was highest (χ2= 78.60, P<0.05) of all.At the same time, the sensitivity(95.65%), specificity(96.77%), positive predictive value(97.78%), negative predictive value(93.75) and accuracy(92.42%) of TB-IGRA for diagnosis of tuberculous pleural effusion were highest of all.

Conclusions

Compared with these traditional detection indicators, TB-IGRA is more sensitive and specific.The combination of TB-IGRA with CEA and ADA detection has very important clinical value in the diagnosis of tuberculouspleural effusion.

Key words: Interferon-gamma, Tuberculosis, Pleural effusion
表1 结核组和恶性组患者胸腔积液血清CEA和胸腔积液ADA水平比较(±s)
组别 例数 血清CEA(μg/L) 胸腔积液ADA(U/L)
结核组 55 2.34±1.80 57.51±26.90
恶性组 49 2358.68±1069.40 14.43±3.57
t值 ? －15.42 11.76
P值 ? <0.05 <0.05
表2 结核组患者IGRA与其他诊断方法阳性率比较
诊断方法 例数 阳性例数 阳性率(%) χ2值 P值
TB-IGRA 55 53 96.36 － －
涂片镜检 53 12 22.64 58.18a <0.05
结核菌素皮试 15 7 46.67 19.89a <0.05
结核杆菌抗体 37 13 35.14 37.94a <0.05
表3 TB-IGRA与涂片镜检、PPD试验、结核杆菌抗体对结核性胸腔积液诊断结果的比较(%)
诊断方法 例数 敏感度 特异度 阳性预测值 阳性预测值 准确性
TB-IGRA 55 95.65 96.77 97.78 93.75 92.42
涂片镜检 53 22.64 93.10 85.71 39.71 15.74
结核菌素试验 15 67.28 92.17 90.38 45.12 59.45
结核杆菌抗体 37 48.37 54.28 58.31 43.72 2.65
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