切换至 "中华医学电子期刊资源库"
高级检索
中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03) : 329 -333. doi: 10.3877/cma.j.issn.1674-6902.2020.03.008

论著

γ-干扰素释放试验在活动性肺结核诊断中的价值
黄德东1, 刘庭贵2, 张云2, 施洁1, 韩湉湉1, 庄建文1, 魏西飞1, 顾兴3,†()   
  1. 1. 310013　杭州，解放军联勤保障部队第903医院感染科
    2. 552100　织金，贵州省织金县人民医院感染科
    3. 710038　西安，空军（第四）军医大学唐都医院呼吸与危重症医学科
  • 收稿日期:2020-01-17 出版日期:2020-06-25
  • 通信作者: 顾兴
  • 基金资助:
    浙江省自然科学基金资助项目(LY15H9001); 浙江省医药卫生科技计划项目(2016KYB248); 解放军联勤保障部队第903医院帮扶织金县人民医院项目(2020-01)

Clinical value of interferon γ release assay in diagnosis of active pulmonary tuberculosis

Dedong Huang1, Tinggui Liu2, Yun Zhang2, Jie Shi1, Tiantian Han1, Jianwen Zhuang1, Xifei Wei1, Xing Gu3,†()   

  1. 1. Department of Infectious Diseases, 903rd Hospital of PLA, Hangzhou 310013, China
    2. Department of Infectious Diseases, Zhijin County People′s Hospital, Zhijin 552100, Guizhou Province, China
    3. Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi′an 710038, China
  • Received:2020-01-17 Published:2020-06-25
  • Corresponding author: Xing Gu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

黄德东, 刘庭贵, 张云, 施洁, 韩湉湉, 庄建文, 魏西飞, 顾兴. γ-干扰素释放试验在活动性肺结核诊断中的价值[J]. 中华肺部疾病杂志(电子版), 2020, 13(03): 329-333.

Dedong Huang, Tinggui Liu, Yun Zhang, Jie Shi, Tiantian Han, Jianwen Zhuang, Xifei Wei, Xing Gu. Clinical value of interferon γ release assay in diagnosis of active pulmonary tuberculosis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(03): 329-333.

目的

在我国西南部结核病高发区，评价结核γ-干扰素释放试验(tuberculosis interferonγ release assay, TB-IGRA)在疑似肺结核中诊断活动性肺结核的价值。

方法

纳入2018年12月20日至2019年12月20日在贵州省织金县人民医院诊断的疑似肺结核患者1 627名，用TB-IGRA、结核菌素皮肤实验(TST)、结核分枝杆菌抗体(TBAb)或结核分枝杆菌免疫球蛋白(TB-Ig)检测诊断活动性肺结核，比较其敏感性、特异性、准确性。并分析卡介苗(Bacillus Calmette-Guérin, BCG)接种对结果的影响。

结果

TB-IGRA的敏感性、特异性和准确性，依次为：91.26%、80.13%和89.37%，均高于TST、TB-IgG的检测。TB-IGRA诊断疑似肺结核中的活动性肺结核，不受BCG接种的影响(χ2＝0.05，P＝0.83)。BCG接种对TST诊断疑似肺结核中的活动性肺结核影响明显(χ2＝108.17，P<0.001)。

结论

TB-IGRA在我国西南部结核病高发区诊断活动性肺结核有很高的敏感性、特异性，较TST、TB-Ig有更高价值，且不受BCG接种的影响。

关键词: 结核γ-干扰素释放试验, 结核菌素试验, 结核分枝杆菌抗体
Objective

To evaluate the clinical value of tuberculosis interferon γ release assay (TB-IGRA) in the diagnosis of active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients in the southwest region of China with high TB burden.

Methods

A total of 1627 suspected pulmonary tuberculosis patients from the Department of Infectious Diseases of Zhijin County People′s Hospital in Guizhou Province in China between December 20, 2018 and December 20, 2019 were enrolled for this study. Then TB-IGRA, tuberculin skin test (TST) and tuberculosis immunoglobulin (TB-Ig) were used respectively to diagnose the active pulmonary tuberculosis. And the sensitivity, specificity and accuracy were compared among the patients with TB-IGRA, TST, and TB-Ig, respectively. The influences of Bacillus Calmette-Guérin (BCG) vaccination on these tests were analyzed.

Results

The sensitivity, specificity and accuracy of TB-IGRA were 91.26%, 80.13%, and 89.37%, respectively, and they were higher than those of TST or TB-IgG. The results of TB-IGRA diagnosis for active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients were not affected by BCG vaccination (χ2=0.05, P=0.83). However, BCG vaccination affected the results of TST significantly (χ2=108.17, P<0.001).

Conclusion

TB-IGRA seems to be superior to TST or TB-IgG as a diagnostic tool for the detection of active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients in southwest region of China with high TB burden and it is not affected by BCG vaccination.

Key words: Tuberculosis interferonγ, release assay, Tuberculin skin test, Tuberculosis antibody
表1 对象人口学资料及卡介苗接种史
组　别 人数(例) 年龄(岁) 性别(男/女) BCGb
疑似肺结核患者 1 627 37.61±21.31 904/723 1 496/131
活动性肺结核患者 1 373 36.88±20.07 768/605 1 268/105
非活动肺结核患者 254 37.94±21.95 145/109 228/26
统计量(F/χ2) -a 4.65 0.81 1.94
  P值 -a 0.15 0.67 0.38
表2 疑似肺结核IGRA、TST、TB-IgG检测结果[n(%)]
检测方法 检测结果 疑似肺结核病例
活动性肺结核 非活动性肺结核
IGRA 阳性 1 253(91.26) 53(20.87)
  阴性 120(8.74) 201(79.13)
TST 阳性 1 043(75.97) 76(29.92)
  阴性 330(24.03) 178(70.08)
TB-IgG 阳性 556(40.50) 65(25.59)
  阴性 817(59.50) 189(74.41)
表3 IGRA、TST与TB-IgG检测结果效能比较(%)
检测方法 敏感性(95%CI) 特异性(95%CI) 阳性预测值(95%CI) 阴性预测值(95%CI) 准确性(95%CI)
IGRA 91.26(81.86～96.50) 80.13(73.07～83.28) 95.94(93.32～97.35) 62.62(60.44～89.04) 89.37(78.83～92.65)
TST 75.97(69.88～83.25) 70.07(67.15～81.39) 93.21(90.85～96.46) 35.04(33.01～49.47) 75.05(71.73～80.17)
TB-IgG 40.50(26.41～54.2) 74.41(59.65～86.06) 89.53(6.25～19.85) 18.79(15.25～21.55) 45.79(42.36～49.91)
表4 BCG疫苗接种对IGRA、TST与TB-IgG诊断活动性肺结核的结果[n(%)]
检测方法 检测结果 活动性肺结核病例
BCG接种 无BCG接种
IGRA 阳性 1 160(91.48) 93(88.57)
  阴性 108(8.52) 12(11.43)
TST 阳性 1 007(79.42) 36(34.29)
  阴性 261(20.58) 69(65.71)
TB-IgG 阳性 517(40.77) 39(37.14)
  阴性 751(59.23) 66(62.86)
表5 BCG疫苗接种对IGRA、TST与TB-IgG诊断非活动性肺结核的结果[n(%)]
检测方法 检测结果 非活动性肺结核病例(254)
BCG接种 无BCG接种
IGRA 阳性 48(26.67) 5(23.81)
  阴性 180(73.33) 21(76.19)
TST 阳性 71(31.14) 5(23.81)
  阴性 157(68.86) 21(76.19)
TB-IgG 阳性 61(26.75) 4(18.18)
  阴性 167(73.25) 22(81.82)
1
任成山，林　辉，杨仕明. 结核病的流行特征与耐多药的窘迫及其策略[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(3): 269-274.
2
方源扬，刘国强，黄显聪，等. 景东县2004-2013年肺结核防治的卫生经济学分析[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(1): 36-40.
3
World Health Organization (WHO): Global tuberculosis control：Surveillance, financing WHO report 2005. Word Health Organization (WHO/HTM/TB/2005.349) Geneva.

URL    
4
Fernández-Carballo BL, Broger T, Wyss R, et al. Toward the Development of a Circulating Free DNA-Based In Vitro Diagnostic Test for Infectious Diseases: a Review of Evidence for Tuberculosis[J]. J Clin Microbiol, 2019, 57(4): pii: e01234-01218.
5
Haas MK, Belknap RW. Belknap Diagnostic Tests for Latent Tuberculosis Infection[J]. Clin Chest Med, 2019, 40 (4): 829-837.
6
Gupta RK, Lipman M, Jackson C, et al. Quantitative Interferon Gamma Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis: A Prospective Cohort Study[J]. Am J Respir Crit Care Med, 2019, doi：10.1164/rccm.201905-0969OC
7
Ai L, Feng P, Chen D, et al. Clinical value of interferon-gamma release assay in the diagnosis of active tuberculosis[J]. Exp Ther Med, 2019, 18 (2): 1253-1257.
8
Wu X, Chen P, Wei W, et al. Diagnostic value of the interferon-gamma release assay for tuberculosis infection in patients with Behcet′s disease[J]. BMC Infect Dis, 2019, 19(1): 323.
9
Ogata T, Nagasu N, Uehara R, et al. Association of Low Sputum Smear Positivity among Tuberculosis Patients with Interferon-Gamma Release Assay Outcomes of Close Contacts in Japan[J]. Int J Environ Res Public Health, 2019, 16 (19): 3713.
10
Abubakar I, Lalvani A, Southern J, et al. Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study[J]. Health Technol Assess, 2018, 22(56): 1-96.
11
中国人民共和国卫生健康委员会(2017). 肺结核诊断标准(ws288-2017).

URL    
12
潘　蕾，鲁　曦，李王平，等. T-Spot.TB与PPD预测家庭密切接触者是否患活动性结核的价值研究 [J/CD]. 中华肺部疾病杂志(电子版), 2018, 11(1): 25-28.
13
Dewi DNSS, Mertaniasih NM, Soedarsono, et al. Characteristic profile of antibody responses to PPD, ESAT-6, and CFP-10 of Mycobacterium tuberculosis in pulmonary tuberculosis suspected cases in Surabaya, Indonesia[J]. Braz J Infect Dis, 2019, 23(4): 246-253.
14
梁　艳，王兰，张翠英，等. 两种γ干扰素释放试验及PPD试验结果在结核感染诊断中的比较[J]. 中国防痨杂志，2015, 37(7): 740-747.
15
Della Bella C, Spinicci M, Alnwaisri HFM, et al. LIOFeron(R)TB/LTBI: A novel and reliable test for LTBI and tuberculosis[J]. Int J Infect Dis, 2019, 91: 177-181.
16
Hamaguchi Y, Yamaguchi T, Nishiura H. Nishiura Estimating the annual risk of tuberculosis infection in Japan from interferon-gamma release assay data[J]. J Theor Biol, 2019, 460: 125-133.
17
Reviono R, Saptawati L, Redhono D, et al. Good Agreement between an Interferon Gamma Release Assay and Tuberculin Skin Tests in Testing for Latent Tuberculosis Infection among HIV-Infected Patients in Indonesia[J]. J Korean Med Sci, 2019, 34(40): e259.
18
卢峰岳，黄艳君，刘春平，等. γ-干扰素释放试验诊断活动性结核病的临床评价[J]. 实用医学杂志，2015, 29(23): 3827-3829.
19
李　明，李　燕，王　超，等. γ-干扰素体外释放酶联免疫定量试验在肺结核病诊断中的应用[J]. 检验医学与临床，2016, 13(2): 333-335.
20
Melinte V. Laboratory diagnosis of tuberculosis-(1) Microbiological diagnosis[J]. Bacteriol Virusol Parazitol Epidemiol, 2008, 53(3): 127-143.
21
Kowada A. Interferon-gamma release assay for tuberculosis screening of solid-organ transplant recipients is cost-effective[J]. J Infect, 2019, 78(1): 58-65.
22
Aguilo N, Gonzalo-Asensio J, Alvarez-Arguedas S, et al. Reactogenicity to major tuberculosis antigens absent in BCG is linked to improved protection against Mycobacterium tuberculosis[J]. Nat Commun, 2017, 8: 16085.
23
Maekura R, Kitada S, Osada-Oka M, et al. Serum antibody profiles in individuals with latent Mycobacterium tuberculosis infection[J]. Microbiol Immunol, 2019, 63(3-4): 130-138.
24
Broger T, Basu Roy R, Filomena A, et al. Diagnostic Performance of Tuberculosis-Specific IgG Antibody Profiles in Patients with Presumptive Tuberculosis from Two Continents[J]. Clin Infect Dis, 2017, 64(7): 947-955.
25
孔海芳，岳　娜，刘　刚，等. 全血γ干扰素释放试验诊断结核病的临床应用价值[J]. 天津医药，2016, 44(9): 1132-1135.
[1] 杨智彬, 申恩瑞, 潘丽, 赵丽惠, 王聪, 杨艳霞, 李阳, 王巧凤, 马世武. 不同临床类型结核病患者血清白细胞介素-21水平及其临床意义[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(01): 48-53.
[2] 王惠娟, 刘嫣然, 江学良. 结核菌素试验和T细胞斑点试验在肠结核中的诊断价值[J]. 中华消化病与影像杂志(电子版), 2020, 10(04): 174-177.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号