【摘要】 目的探讨γ-干扰素释放试验(IGRA)、抗-结核分枝杆菌及其组合在肺结核诊断中的应用价值。方法回顾性调查苏州大学附属传染病医院结核病科于2013年6月至2014年12月收治的符合要求、资料完整的疑似肺结核病例共512例,采用IGRA试剂盒检测其血浆γ-干扰素含量,同时应用蛋白芯片识别仪检测其结核分枝杆菌蛋白16 kDa和38 kDa以及抗-脂阿拉伯甘露糖(Lam)含量,应用ELISA检测抗-结核分枝杆菌(TBAb),并将5种检测结果进行平行分析。结果在涂阴肺结核的单一检测指标中,IGRA的AUC最大,诊断效能最好。在各项指标联合检测中,二联组合16 kD+IGRA和三联组合IGG+16 kD+IGRA较好,且两种组合的检验效能差异无统计学意义(Z=1.622、P=1.107),AUC分别为0.694和0.667,灵敏度分别为82%和96%,特异度分别为57%和36%。结论多项检测指标联合较单一指标检测能够提高涂阴肺结核诊断的灵敏度。16 kD+IGRA和IGG+16 kD+IGRA为IGRA、抗-分枝杆菌在涂阴肺结核诊断中的最优组合。更多还原

【Abstract】 Objective To investigate the potential value of interferon-gamma release assay(IGRA) and detection of anti-Mycobacterium tuberculosis(MTB) in the diagnosis of tuberculosis. Methods Data of 512 cases with suspected tuberculosis diagnosed from June 2013 to December 2014 in Department of Tuberculosis, the Fifth Affiliated Infectious Hosptital of Soochow University were analyzed, retrospectively. The concentration of interferon-gamma in blood plasma were detected by the IGRA kit. The concentration of anti-MTB-16 kD, anti-MTB-38 kD and anti-lipoarabinomannan(Lam) were detected by protein chip recognition instrument. The level of anti-tuberculosis(TBAb) was analyzed by ELISA method. The accuracy of diagnosis of tuberculosis based on single measurement or combination of them were evaluated through parallel comparison. Results For the cases with smear negative pulmonary tuberculosis, AUC of IGRA was the largest, indicating the best diagnostic accuracy. When combined with these indicators, a duplex combination of 16 kD + IGRA and a triple combination of IGG + 16 kD + IGRA showed better accuracy, but with no significant difference between the two combinations(Z = 1.622, P = 1.107). The AUC, sensitivity and specificity values of combination of 16 kD + IGRA were 0.694, 82% and 57%, respectively. The AUC, sensitivity and specificity values of combination of IGG + 16 kD + IGRA were 0.667, 96% and 36%, respectively. Conclusions Comparing with the single parameter, the combined multiple parameters may improve the sensitivity of diagnosis in smear negative pulmonary tuberculosis. The significant combinations of parameters in diagnosing smear negative pulmonary tuberculosis are 16 kD + IGRA and IGG + 16 kD + IGRA.更多还原