γ干扰素释放试验在肺内结核和肺外结核中的诊断价值

目的：探讨IFN-γ释放试验在肺内及肺外结核诊断中的应用价值。方法采用IFN-γ释放试验试剂盒分别检测185例结核病患者（包括119例肺结核和66例肺外结核）、139例其他肺部疾病患者和100例健康对照者结核患病情况，并以病原培养或/和临床诊断为标准，评价IFN-γ法诊断的敏感度和特异性，同时分别与痰菌培养及痰涂片平行检验的结果作比较。结果以临床诊断为准金标准，IFN-γ释放试验检测敏感度为93.51%，特异度为84.52%，检测肺结核和肺外结核的敏感度分别为90.76%和98.49%，两者差异无统计学意义（P〉0.05）；而痰涂片检测肺结核和肺外结核的敏感度分别为11.76%和3.03%；痰培养检测的敏感度也仅为24.37%和3.03%，3种方法对肺结核和肺外结核检测敏感度，差异均有统计学意义（ P均〈0.05）。全部424例标本，经培养阳性有33例，其中鉴定发现2例非结核分枝杆菌感染，均为脓肿分枝杆菌，IFN-γ释放试验检测为阴性，按鉴定确认的31例结核分支杆菌培养阳性结果为金标准，IFN-γ释放试验敏感度为90.32%（95%CI：75.10%~96.65%）。结论IFN-γ释放试验肺内、外结核具有快速方便和较高的敏感度，值得用于临床结核筛查。

The diagnosis values of whole blood IFN-γrelease assay on pulmonary tuberculosis and extra-pulmonary tuberculosis

Objective To evaluate the diagnosis values of whole blood IFN-γ release assay on pulmonary tuberculosis （ TB）and extra-pulmonary tuberculosis. Methods One hundred and eighty five patients with tuberculosis（ including 119 pulmonary TB and 66 extra-pulmonary TB）,139 patients with other respiratory diseases and 100 healthy people were enrolled. Mycobacterium tuberculosis infection testing was conducted with methods of IFN -γ release assay,sputum bacterial culture and sputum smear,respectively. Results of pathogen culture and/or clinical diagnosis were used as the golden standard to evaluate the sensitivity and specificity of these three methods. Results Compared with the results of clinical diagnosis,the sensitivity and specificity of IFN-γ release assays was 93. 51% and 84. 52%,respectively. There was no significant difference in sensitivity between pulmonary diagnosis（ 90. 76%） and extra - pulmonary diagnosis （98. 49%）（P〉0. 05）. The sensitivity of sputum smear was 11. 76% in patients with pulmonary and 3. 03% in patients with extra - pulmonary. And the sensitivity of sputum bacterial culture in these two patient groups was 24. 37% and 3. 03%,respectively. Sensitivity of the IFN-γ release assay was higher than that of sputum culture and sputum smear （P〈0. 05）. The results of pathogen culture showed that 33 of 424 samples were positive,in which 2 were mycobacterium abscessus positive and 31 were mycobacterium tuberculosis positive. Compared with the results of pathogen culture,the sensitivity of IFN-γrelease assay was 90. 32%（95%CI：75. 10% -96. 65%）. Conclusion IFN-γrelease assay is a fast,sensitive and convenient method to detect pulmonary and extra pulmonary tuberculosis. It is worthy to be applied to clinical practice.