γ干扰素释放试验用于结核病诊断的临床应用价值

目的探讨γ干扰素释放试验(TB-IGRA)对肺内肺外结核病的诊断价值。方法选择肺内结核70例,肺外结核33例及正常对照组30例,分别采用ESAT-6和CFP-10肽段库为刺激原,全血培养1 d,应用EL-ISPOT检测培养上清液γ干扰素释放特异T细胞,诊断结核分枝杆菌感染,并与结核菌素皮肤试验(TST)进行比较。结果ESAT-6刺激斑点形成T细胞中位数肺内结核组为442/106,肺外结核组为196/106;正常对照组为22/106;CFP-10刺激斑点形成T细胞中位数肺内结核组为619/106,肺外结核组为274/106,正常对照组为24/106。不受机体免疫及卡介苗接种的影响,TB-IGRA检测敏感性肺内结核组为97.14%,肺外结核组为93.94%,正常对照组为90.00%(阴性率)。TST(PPD)皮肤试验敏感性肺内结核组约为64%,肺外结核组约为48%,正常对照组约为56%(阴性率)。结论TB-IGRA对肺内肺外结核分枝杆菌感染(结核病)诊断均具有较高的敏感性。

The Clinical Value of TB-IGRA for Diagnosis of Tuberculosis

Objective To discuss the diagnosis value of TB-IGRA for the tuberculosis inside and outside the lungs. Methods Seventy cases of tuberculosis inside the lungs, 33 cases of tuberculosis outside the lungs and 30 cases of control groups were studied. The ESAT-6 and CFP-10 peptide pools were chosen as the stimuli source. The whole blood culture was done for a day. The EL-ISPOT were adopted to detect and cultivate the IFN-γ/ in supernatant and release the specific T cell so as to get the diagnosis of mycobae- terium tuberculosis infection then compare the results with those of Tuberculin Skin Test （TST）. Results The median amount of T cell formed in the macula stimulated by ESAT-6 in the group inside lungs, outside lungs and control groups were 442/10^6, 196/10^6 and 22/10^6 respectively. The median amount of T cell formed in the macula stimulated by CFP-10 in the group inside lungs, outside lungs and control groups were 619/10^6, 274/10^6 and 24/10^6 respectively, and will not be affected by the subject＇s immune status and the Bacillus Calmette-Guerin Vaccmation. The sensitivity of TB-IGRA for the detection of tuberculosis inside lung, outside lung and control groups were 97.14%, 93.94% and 90.00% respectively in term of negative ratio. The sensitivity of tuberculin skin test （TST） with PPD for tuberculosis inside lungs, outside lungs and control groups were 64%, 48% and 56% respectively in term of negative ratio. Conclusion TB- IGRA shows high sensitivity for mycobacterium tuberculosis infection inside and outside lungs.