胸水γ干扰素释放试验在结核性胸膜炎中的诊断价值
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摘要
目的探讨胸水γ干扰素释放试验(IGRA)在结核性胸膜炎中的诊断价值。方法选取2015年2月~2016年3月因胸腔积液于徐州市传染病医院就诊的患者84例,其中临床诊断为结核性胸膜炎46例、非结核性胸膜炎38例,分别采集患者外周血进行γ干扰素水平测定,采集胸水进行γ干扰素和腺苷脱氨酶水平测定,以临床诊断结果作为金标准,比较三种检测方式诊断结核性胸膜炎的灵敏度和特异度以及检测结果一致性,利用Med Calc软件比较三种检测方式ROC曲线面积大小。结果以临床诊断结果作为金标准,外周血IGRA、胸水IGRA以及腺苷脱氨酶(ADA)检测诊断结核性胸膜炎灵敏度依次为65.22%、89.13%、71.74%,特异度依次为68.42%、94.73%、78.95%。胸水IGRA灵敏度高于为外周血IGRA(χ2=7.466,P=0.006)和胸水ADA(χ2=4.420,P=0.036),胸水IGRA特异度高于为外周血IGRA(χ2=8.756,P=0.003)和胸水ADA(χ2=4.145,P=0.042)。外周血和胸水IGRA检测结果一致性较差(Kappa=0.167),胸水IGRA和ADA检测结果一致性较好(Kappa=0.572)。外周血IGRA、胸水IGRA以及ADA检测ROC曲线下面积分别为0.753、0.966、0.814。胸水IGRA检测ROC曲线面积明显大于外周血IGRA检测(Z=3.923,P<0.001)和胸水ADA检测(Z=2.779,P=0.005)。结论胸水IGRA在结核性胸膜炎中的诊断效能优于另外两种检测方法,胸水IGRA可以推广为临床上快速诊断结核性胸膜炎的辅助手段。
Objective To investigate the diagnostic value of pleural fluid interferon gamma release assay(IGRA) in patients with tuberculous pleurisy. Methods From February 2015 to March 2016, 84 pleural effusion patients in Xuzhou Infectious Disease Hospital were selected, including 46 cases of tuberculous pleurisy, 38 cases of non-tuberculous pleurisy. Peripheral blood were collected to test γ-interferon levels, and pleural fluid were collected to test γ-interferon and adenosine deaminase levels. Taking clinical diagnosis as the gold standard, the sensitivity, specificity and consistency of the test results of the three detection methods were compared, the three ROC curves were compared by Med Calc software. Results According to clinical diagnosis, the sensitivity of peripheral blood IGRA, pleural fluid IGRA and adenosine deaminase(ADA) were 65.22%, 89.13% and 71.74%, the specificity of peripheral blood IGRA, pleural fluid IGRA and ADA were 68.42%, 94.73% and 78.95%. The sensitivity of pleural fluid IGRA was higher than peripheral blood IGRA(χ2=7.466, P = 0.006) and pleural fluid ADA(χ2=4.420, P = 0.036). The specificity of pleural fluid IGRA was higher than peripheral blood IGRA(χ2=8.756, P = 0.003) and pleural fluid ADA(χ2=4.145, P = 0.042). The detection result of peripheral blood IGRA and pleural fluid IGRA were in poor agreement(Kappa=0.167). The detection result of pleural fluid IGRA and pleural fluid ADA were in good agreement(Kappa=0.572). The area under the ROC curve of peripheral blood IGRA was 0.753, and the area under the ROC curve of pleural fluid γ-interferon and ADA were 0.966, 0.814. The area under the ROC curve of pleural fluid IGRA was bigger than peripheral blood IGRA(Z =3.923, P < 0.001) and pleural fluid ADA(Z = 2.779, P = 0.005). Conclusion The diagnostic value of tuberculous pleurisy by the method of pleural fluid IGRA are much better than the other two methods, pleural fluid IGRA can be promoted to be the method for rapid diagnosis of tuberculous pleurisy.
Objective To investigate the diagnostic value of pleural fluid interferon gamma release assay(IGRA) in patients with tuberculous pleurisy. Methods From February 2015 to March 2016, 84 pleural effusion patients in Xuzhou Infectious Disease Hospital were selected, including 46 cases of tuberculous pleurisy, 38 cases of non-tuberculous pleurisy. Peripheral blood were collected to test γ-interferon levels, and pleural fluid were collected to test γ-interferon and adenosine deaminase levels. Taking clinical diagnosis as the gold standard, the sensitivity, specificity and consistency of the test results of the three detection methods were compared, the three ROC curves were compared by Med Calc software. Results According to clinical diagnosis, the sensitivity of peripheral blood IGRA, pleural fluid IGRA and adenosine deaminase(ADA) were 65.22%, 89.13% and 71.74%, the specificity of peripheral blood IGRA, pleural fluid IGRA and ADA were 68.42%, 94.73% and 78.95%. The sensitivity of pleural fluid IGRA was higher than peripheral blood IGRA(χ2=7.466, P = 0.006) and pleural fluid ADA(χ2=4.420, P = 0.036). The specificity of pleural fluid IGRA was higher than peripheral blood IGRA(χ2=8.756, P = 0.003) and pleural fluid ADA(χ2=4.145, P = 0.042). The detection result of peripheral blood IGRA and pleural fluid IGRA were in poor agreement(Kappa=0.167). The detection result of pleural fluid IGRA and pleural fluid ADA were in good agreement(Kappa=0.572). The area under the ROC curve of peripheral blood IGRA was 0.753, and the area under the ROC curve of pleural fluid γ-interferon and ADA were 0.966, 0.814. The area under the ROC curve of pleural fluid IGRA was bigger than peripheral blood IGRA(Z =3.923, P < 0.001) and pleural fluid ADA(Z = 2.779, P = 0.005). Conclusion The diagnostic value of tuberculous pleurisy by the method of pleural fluid IGRA are much better than the other two methods, pleural fluid IGRA can be promoted to be the method for rapid diagnosis of tuberculous pleurisy.
引文
[1]李志惠,赵杰,崔丹,等.胸液中IFN-γ对结核性胸膜炎的诊断价值[J].临床肺科杂志,2014,19(6):1064-1066.
[2]许销销.结核性胸腔积液中相关指标与胸膜增厚的关系[D].武汉:华中科技大学,2014.
[3]刘安,陈余清,李伟,等.结核感染T细胞斑点试验对结核性胸膜炎的诊断价值[J].山西医科大学学报,2016,47(1):64-67.
[4]杨亚利,彭小东,韩文群.恶性肿瘤患者胸腔积液结核杆菌DNA检测的临床意义[J].成都医学院学报,2015,10(2):203-205.
[5]李津,潘燕玉,张宝华,等.IGRA检测在结核性胸膜炎中的诊断价值[J].临床肺科杂志,2014,19(6):1055-1057.
[6]杨昌恒,廖江荣,徐巧伶.T-SPOT在结核性胸膜炎的临床诊断价值[J].实用医学杂志,2015,19(31):3279-3280.
[7]崔丹,李志惠,赵杰,等.胸水酶联免疫斑点检测在结核性胸膜炎中的诊断价值[J].河北医药,2015,37(8):1191-1193.
[8]傅京力,李远,谭英征,等.干扰素-γ、腺苷脱氨酶水平对结核性胸膜炎的诊断价值[J].中国医药导报,2014,11(12):25-27.
[9]吴纯,李妮,佟爱华,等.人结核分支杆菌相关干扰素-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.
[10]董雅坤,栗爱珍,郑立恒,等.腺苷脱氨酶、γ干扰素和γ干扰素释放蛋白10对结核性胸膜炎的诊断作用研究[J].解放军医学杂志,2015,40(6):458-462.
[11]Ates G,Yidiz T,Ortakoylu MG,et al.Adapted T cell interferon gamma release assay for the diagnosis of pleural Tuberculosis[J].Respiration,2011,82(4):351-357.
[12]Liu F,Gao M,Zhang X,et al.Interferon gamma release assay performance of pleural fluid and peripheral blood in pleural tuberculosis[J].PLo S One,2013,8(12):3853-3857.
[13]Kang JY,Rhee CK,Kang NH,et al.Clinical utility of two international-gamma release assays on pleural fluid for the diagnosis of tuberculous pleurisy[J].Tuberc Respir Dis(Seoul),2012,73(3):143-145.
[14]石菡,袁媛,李艳芳,等.结核感染T细胞斑点试验对结核性胸膜炎的临床诊断分析[J].中华医院感染学杂志,2016,26(7):1486-1488.
[15]王宏,王永志.ADA、LDH和CEA在胸腔积液鉴别诊断中的应用价值[J].临床肺科杂志,2012,17(3):567-569.
[16]李多孚,陈郁琳,夏雨.胸水ADA、LDH诊断结核性胸膜炎的临床效能评价[J].检验医学,2015,30(10):987-990.
[17]罗虎,宫亮,周向东.胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨[J].重庆医学,2012,41(35):3718-3722.
[18]刘卫,凌宙贵,汪春梅,等.胸膜活检结合胸水腺苷酸脱氨酶的测定在诊断结核性胸膜炎中的作用[J].实用诊断与治疗杂志,2008,22(2):128-129.
[19]凌宙贵,刘卫,蒋连强,等.胸膜活检、结核分枝杆菌-PCR及腺苷脱氨酶联合检测诊断结核性胸膜炎[J].中华实用诊断与治疗杂志,2008,22(11):844-845.
[20]李光明,陆小娜,方育霞.胸腔积液腺苷脱氨酶在诊断结核性胸膜炎中的价值[J].实用医学杂志,2012,28(20):3429-3430.
[2]许销销.结核性胸腔积液中相关指标与胸膜增厚的关系[D].武汉:华中科技大学,2014.
[3]刘安,陈余清,李伟,等.结核感染T细胞斑点试验对结核性胸膜炎的诊断价值[J].山西医科大学学报,2016,47(1):64-67.
[4]杨亚利,彭小东,韩文群.恶性肿瘤患者胸腔积液结核杆菌DNA检测的临床意义[J].成都医学院学报,2015,10(2):203-205.
[5]李津,潘燕玉,张宝华,等.IGRA检测在结核性胸膜炎中的诊断价值[J].临床肺科杂志,2014,19(6):1055-1057.
[6]杨昌恒,廖江荣,徐巧伶.T-SPOT在结核性胸膜炎的临床诊断价值[J].实用医学杂志,2015,19(31):3279-3280.
[7]崔丹,李志惠,赵杰,等.胸水酶联免疫斑点检测在结核性胸膜炎中的诊断价值[J].河北医药,2015,37(8):1191-1193.
[8]傅京力,李远,谭英征,等.干扰素-γ、腺苷脱氨酶水平对结核性胸膜炎的诊断价值[J].中国医药导报,2014,11(12):25-27.
[9]吴纯,李妮,佟爱华,等.人结核分支杆菌相关干扰素-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.
[10]董雅坤,栗爱珍,郑立恒,等.腺苷脱氨酶、γ干扰素和γ干扰素释放蛋白10对结核性胸膜炎的诊断作用研究[J].解放军医学杂志,2015,40(6):458-462.
[11]Ates G,Yidiz T,Ortakoylu MG,et al.Adapted T cell interferon gamma release assay for the diagnosis of pleural Tuberculosis[J].Respiration,2011,82(4):351-357.
[12]Liu F,Gao M,Zhang X,et al.Interferon gamma release assay performance of pleural fluid and peripheral blood in pleural tuberculosis[J].PLo S One,2013,8(12):3853-3857.
[13]Kang JY,Rhee CK,Kang NH,et al.Clinical utility of two international-gamma release assays on pleural fluid for the diagnosis of tuberculous pleurisy[J].Tuberc Respir Dis(Seoul),2012,73(3):143-145.
[14]石菡,袁媛,李艳芳,等.结核感染T细胞斑点试验对结核性胸膜炎的临床诊断分析[J].中华医院感染学杂志,2016,26(7):1486-1488.
[15]王宏,王永志.ADA、LDH和CEA在胸腔积液鉴别诊断中的应用价值[J].临床肺科杂志,2012,17(3):567-569.
[16]李多孚,陈郁琳,夏雨.胸水ADA、LDH诊断结核性胸膜炎的临床效能评价[J].检验医学,2015,30(10):987-990.
[17]罗虎,宫亮,周向东.胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨[J].重庆医学,2012,41(35):3718-3722.
[18]刘卫,凌宙贵,汪春梅,等.胸膜活检结合胸水腺苷酸脱氨酶的测定在诊断结核性胸膜炎中的作用[J].实用诊断与治疗杂志,2008,22(2):128-129.
[19]凌宙贵,刘卫,蒋连强,等.胸膜活检、结核分枝杆菌-PCR及腺苷脱氨酶联合检测诊断结核性胸膜炎[J].中华实用诊断与治疗杂志,2008,22(11):844-845.
[20]李光明,陆小娜,方育霞.胸腔积液腺苷脱氨酶在诊断结核性胸膜炎中的价值[J].实用医学杂志,2012,28(20):3429-3430.