快速诊断技术在活动性肺结核的临床应用价值

目的探讨联合应用痰抗酸涂片、γ-干扰素体外释放试验(TB-IGRA)、TB-DNA在活动性肺结核诊断的临床应用价值。方法选取苏州第五人民医院肺结核患者803例,以肺部非结核疾病患者216例作对照,采用以上3种快速诊断技术进行检测,研究其在活动性肺结核的诊断效能。结果单一检测指标曲线下面积(AUC)两两比较,痰抗酸涂片检测AUC(0.675)最小,诊断效能最差,其敏感性及特异性分别为35.87%、99.07%;TB-IGRA检测AUC(0.771)最大,诊断效能最好,其敏感性及特异性分别为88.54%、65.74%。二联或三联组合检测两两比较,痰抗酸涂片+TB-IGRA、TB-IGRA+TB-DNA及痰涂片+TB-IGRA+TB-DNA的AUC较大,均大于痰抗酸涂片+TB-DNA,差异有统计学意义(P0.05),而痰抗酸涂片+TB-IGRA、TB-IGRA+TB-DNA及痰涂片+TB-IGRA+TB-DNA间差异无统计学意义(P0.05)。结论与单一指标诊断比较,多项指标联合诊断可提高其肺结核诊断的敏感性,从成本效益学角度考虑,痰抗酸涂片+TB-IGRA、TB-IGRA+TB-DNA联合检测AUC较大,检验效能较好。

Study on clinical application value of rapid diagnosis technology in active pulmonary tuberculosis

Objective To investigate the clinical application value of combined application of sputum smear acid‐fast staining ,tu‐berculosis‐interferon gamma release assay (TB‐IGRA ) and TB‐DNA in the diagnosis of active pulmonary tuberculosis (TB ) . Methods A total of 803 cases of pulmonary TB and 216 cases of non‐TB lung disease as controls were selected .The above 3 kinds of fast diagnostic technology were adopted for conducting the detection .Their efficiency for diagnosing active pulmonary TB was in‐vestigated .Results In the pairwise comparison of the area under curve(AUC) of single detection indicator ,AUC of sputum smear acid‐fast staining was minimal(0 .675) with the worst diagnostic efficiency ,its sensitivity and specificity were 35 .87% and 99 .07%respectively ;AUC of TB‐IGRA was maximum (0 .771 ) with the best diagnostic efficiency ,its sensitivity and specificity were 88 .54% and 65 .74% respectively .In the pairwise comparison of the bigeminy and trigeminy combinations ,AUC of sputum smear acid‐fasting staining+ TB‐IGRA ,TB‐IGRA + TB‐DNA and sputum smear acid‐fast staining + TB‐IGRA + TB‐DNA was larger , which was greater than that of sputum smear acid‐fast staining+ TB‐DNA ,the difference was statistically significant (P<0 .05) . However ,the difference among the sputum smear acid‐fast staining+ TB‐IGRA ,TB‐IGRA+ TB‐DNA and sputum smear acid‐fast staining+ TB‐IGRA+ TB‐DNA was not statistically significant (P>0 .05) .Conclusion Compared with single indicator diagnosis , the combination diagnosis of multiple indicators can increase the sensitivity for diagnosing pulmonary TB .From the perspective of cost and effectiveness ,the combined detections of sputum smear acid‐fast staining+ TB‐IGRA and TB‐IGRA+ TB‐DNA have larger AUC with better detection efficiency .