干扰素体外释放酶联免疫法在孤立性肺结节诊断中的价值
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摘要
目的评价干扰素体外释放酶联免疫法(TB-IGRA)在以孤立性肺结节病灶为主要表现的结核病中的临床应用价值。方法选取60例经病理确诊为结核病和90例确诊为肺恶性肿瘤的肺内孤立性结节患者,作为结核组和非结核组。采用TB-IGRA检测结核感染T细胞的IFN-γ释放量,同时对患者进行结核菌素皮肤试验(TST)。以病理结果作为金标准,对TB-IGRA和TST的检测结果进行分析,绘制受试者工作特征(ROC)曲线,比较两种方法的诊断价值。结果TB-IGRA检测结核的灵敏度为80.0%,特异度为87.78%,阳性预测值为81.36%,阴性预测值为86.81%,均显著高于TST(P<0.001),ROC曲线下面积为0.923(95%CI:0.881~0.964)。结核组的IFN-γ释放量明显高于非结核组(P<0.001)。结论 IGRA在判定肺结节病灶是否为结核病方面的准确性明显优于TST。
Objective To evaluate the clinical value of quantitative diagnostic kit for Mycobacterium tuberculosis interferon-γ(IFN-γ)release assay in patients with solitary pulmonary nodule.Methods A total of 60 patients with solitary pulmonary nodules diagnosed as tuberculosis and 90 patients with solitary pulmonary nodules diagnosed as pulmonary malignant tumors were analyzed retrospectively in the study.All cases were divided into tuberculosis group and non-tuberculosis group.In vitro release of IFN-γwas detected by quantitative diagnostic kit for Mycobacterium tuberculosis IFN-γrelease assay(TB-IGRA)and tuberculin skin test(TST)were performed in all cases.Pathological results were regarded as gold standard for the final diagnosis of the lesions.The results of TB-IGRA were compared with TST,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of the above two methods.Results The sensitivity of TB-IGRA test in detection of tuberculosis was 80.0%,the specificity was 87.78%,the positive predictive value was 81.36% and the negative predictive value was 86.81%,which were significantly better than those of TST(P<0.001).The area under ROC curve was 0.923(95%CI:0.881-0.964).The release of IFN-γin the tuberculosis group was significantly higher than that in the non-tuberculosis group(P<0.001).Conclusion The accuracy of TB-IGRA detection in patients with solitary pulmonary nodules was significantly better than that of TST in the determination of whether the nodule was tuberculosis,which provides a high clinical application value.
Objective To evaluate the clinical value of quantitative diagnostic kit for Mycobacterium tuberculosis interferon-γ(IFN-γ)release assay in patients with solitary pulmonary nodule.Methods A total of 60 patients with solitary pulmonary nodules diagnosed as tuberculosis and 90 patients with solitary pulmonary nodules diagnosed as pulmonary malignant tumors were analyzed retrospectively in the study.All cases were divided into tuberculosis group and non-tuberculosis group.In vitro release of IFN-γwas detected by quantitative diagnostic kit for Mycobacterium tuberculosis IFN-γrelease assay(TB-IGRA)and tuberculin skin test(TST)were performed in all cases.Pathological results were regarded as gold standard for the final diagnosis of the lesions.The results of TB-IGRA were compared with TST,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of the above two methods.Results The sensitivity of TB-IGRA test in detection of tuberculosis was 80.0%,the specificity was 87.78%,the positive predictive value was 81.36% and the negative predictive value was 86.81%,which were significantly better than those of TST(P<0.001).The area under ROC curve was 0.923(95%CI:0.881-0.964).The release of IFN-γin the tuberculosis group was significantly higher than that in the non-tuberculosis group(P<0.001).Conclusion The accuracy of TB-IGRA detection in patients with solitary pulmonary nodules was significantly better than that of TST in the determination of whether the nodule was tuberculosis,which provides a high clinical application value.
引文
[1]中华医学会呼吸病学分会肺癌学组,中国肺癌防治联盟专家组.肺部结节诊治中国专家共识[J].中华结核和呼吸杂志,2015,38(4):249-254.
[2]李志杰,刘倩,冯桂新,等.肺内小结节病变的临床特征分析[J].中国全科医学,2013,16(58):1677-1678.
[3]宋勇,姚艳雯.肺部小结节的诊断和治疗近况[J].中华肺部疾病杂志:电子版,2012,5(4):1-4.
[4]WHO.Global Tuberculosis Report 2016[R/OL].[2017-1-2].http://www.who.int/tb/publications/global_report/en/.
[5]Houben R M,Dodd P J.The global burden of latent tuberculosis infection:a re-estimation using mathematical modelling[J].PLos Med,2016,13(10):e1002152.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]Pai M,Zwerling A,Menzies D.Systematic review:T-cellbased assays for the diagnosis of latent tuberculosis infection:an update[J].Ann Intern Med,2008,149:177-184.
[8]翁绳凤,刘佳文,康丽军,等.干扰素体外释放酶联免疫法在结核潜伏感染诊断中的价值[J].临床肺科杂志,2012,17(6):1062-1064.
[9]李晓非,赵勤,汪亚玲,等.两种结核分枝杆菌相关γ-干扰素定量检测试剂盒检测结核分枝杆菌感染结果比较研究[J].中国防痨杂志,2011,33(5):267-270.
[10]曹英迪.干扰素体外释放酶联免疫法对结核病的诊断价值[J].实验与检验医学,2016,34(2):215-218.
[11]吴纯,李妮,佟爱华,等.人结核分枝杆菌相关干扰素-γ释放酶联免疫法对结核病诊断价值的探讨[J].标记免疫分析与临床,2016,23(3):244-247.
[12]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,2014,2(3):187-190.
[13]Chang P C,Wang P H,Chen K T.Use of the QuantiFERONTB gold in-tube test in the diagnosis and monitoring of treatment efficacy in active pulmonary tuberculosis[J].Int J Environ Res Public Health,2017,14(3):E236.
[2]李志杰,刘倩,冯桂新,等.肺内小结节病变的临床特征分析[J].中国全科医学,2013,16(58):1677-1678.
[3]宋勇,姚艳雯.肺部小结节的诊断和治疗近况[J].中华肺部疾病杂志:电子版,2012,5(4):1-4.
[4]WHO.Global Tuberculosis Report 2016[R/OL].[2017-1-2].http://www.who.int/tb/publications/global_report/en/.
[5]Houben R M,Dodd P J.The global burden of latent tuberculosis infection:a re-estimation using mathematical modelling[J].PLos Med,2016,13(10):e1002152.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]Pai M,Zwerling A,Menzies D.Systematic review:T-cellbased assays for the diagnosis of latent tuberculosis infection:an update[J].Ann Intern Med,2008,149:177-184.
[8]翁绳凤,刘佳文,康丽军,等.干扰素体外释放酶联免疫法在结核潜伏感染诊断中的价值[J].临床肺科杂志,2012,17(6):1062-1064.
[9]李晓非,赵勤,汪亚玲,等.两种结核分枝杆菌相关γ-干扰素定量检测试剂盒检测结核分枝杆菌感染结果比较研究[J].中国防痨杂志,2011,33(5):267-270.
[10]曹英迪.干扰素体外释放酶联免疫法对结核病的诊断价值[J].实验与检验医学,2016,34(2):215-218.
[11]吴纯,李妮,佟爱华,等.人结核分枝杆菌相关干扰素-γ释放酶联免疫法对结核病诊断价值的探讨[J].标记免疫分析与临床,2016,23(3):244-247.
[12]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,2014,2(3):187-190.
[13]Chang P C,Wang P H,Chen K T.Use of the QuantiFERONTB gold in-tube test in the diagnosis and monitoring of treatment efficacy in active pulmonary tuberculosis[J].Int J Environ Res Public Health,2017,14(3):E236.