胸水γ-干扰素释放试验在诊断结核性胸膜炎中的应用
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摘要
目的探讨胸水γ-干扰素释放试验在诊断结核性胸膜炎中的应用效果及与用聚合酶链式反应检测结核分枝杆菌DNA的应用效果的比较分析。方法选取2015年3月-2017年9月住院并伴有发热、畏寒、出汗、乏力及胸腔积液明显增多、临床高度怀疑结核性胸膜炎的患者363例作为研究对象,在其用药前采集胸水分别进行γ-干扰素释放试验和结核分枝杆菌DNA的检测。结果结核性胸膜炎组108例中105例IFN-γ阳性,与TB-DNA结果一致,符合率为97.22%。非结核性胸膜炎组255例中245例IFN-γ阴性,TB-DNA结果一致符合率为96.08%。2组结果的一致性比较差异无统计学意义(P>0.05)。结论γ-干扰素释放试验与用聚合酶链式反应检测结核分枝杆菌DNA同样可以用于结核性胸膜炎的诊断。
Objective To investigate the application of chest water interferon-gamma(IFN-γ) release assays(IGRA) in the diagnosis of tuberculous pleurisy, and to compare the application efficiency in the detection of DNA(TB-DNA) of Mycobacterium tuberculosis by PCR. Methods From March 2016 to September 2017, 363 patients with fever, chills, sweating, fatigue, and increased details of pleural effusion were selected for study. Before drug use, chest water was collected and tested by IGRA and TB-DNA, respectively. Results In 108 cases of tuberculous pleurisy, 105 cases were positive for IFN-γ, and the results were consistent with those of TB-DNA. The coincidence rate was 97.22%. In 255 of non tuberculous pleurisy group, 245 cases were negative for IFN-γ, and the TB-DNA coincidence rate was 96.08%. There was no statistical significance on the difference in consistency between the two groups(P>0.05). Conclusion IFN-γ release test can be used for the diagnosis of tuberculous pleurisy, and PCR method can also used to detect the DNA of Mycobacterium tuberculosis.
Objective To investigate the application of chest water interferon-gamma(IFN-γ) release assays(IGRA) in the diagnosis of tuberculous pleurisy, and to compare the application efficiency in the detection of DNA(TB-DNA) of Mycobacterium tuberculosis by PCR. Methods From March 2016 to September 2017, 363 patients with fever, chills, sweating, fatigue, and increased details of pleural effusion were selected for study. Before drug use, chest water was collected and tested by IGRA and TB-DNA, respectively. Results In 108 cases of tuberculous pleurisy, 105 cases were positive for IFN-γ, and the results were consistent with those of TB-DNA. The coincidence rate was 97.22%. In 255 of non tuberculous pleurisy group, 245 cases were negative for IFN-γ, and the TB-DNA coincidence rate was 96.08%. There was no statistical significance on the difference in consistency between the two groups(P>0.05). Conclusion IFN-γ release test can be used for the diagnosis of tuberculous pleurisy, and PCR method can also used to detect the DNA of Mycobacterium tuberculosis.
引文
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[17] 高鸣,李丽雅,邓西子,等.γ-干扰素释放试验在广州地区艾滋病合并疑似结核人群中的诊断价值[J].热带医学杂志,2017,17(9):1137-1140.
[18] 李月翠,周晶,李成行,等.结核性与癌性胸腔积液的鉴别诊断[J].中华医院感染学杂志,2014,19(24):4787- 4789.
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[23] Keng LT,Shu CC,Chen JY,et al.Evaluating pleural ADA,ADA2,IFN-γ and IGRA for diagnosing tuberculous pleurisy[J].J Infect,2013,67(4):294-302.
[2] 唐神结,高文.临床结核病学[M].北京:人民卫生出版社,2011:23-28.
[3] 孙家兴,于文成,胡海燕,等.恶性胸腔积液与结核性胸腔积液的诊断进展[J].现代生物医学进展,2013,13(14):2780-2782.
[4] 王俊,戴亚新,刘君,等.胸水γ-干扰素特异性效应T细胞检测对结核性胸膜炎诊断的价值评估[J].中国实验诊断学,2018,22(3):430-432.
[5] 李晓非,李明武,苏俊华,等.体外γ-干扰素检测结核分枝杆菌不同方法的应用价值比较[J].中国医院感染学杂志,2012,22(13):2952-2954.
[6] 李慧敏,马清光,李洪英.胸腔积液γ-干扰素释放试验对结核性胸腔积液诊断价值的Mate分析[J].检验医学,2018,33(2):139-146.
[7] 韦海旭,席薇莲,陆利欢,等.γ-干扰素释放分析T-SPOT.TB在结核性疾病中的诊断价值[J].临床肺科杂志,2012,17(8):1439-1440.
[8] 田瑞雪,马丽萍,武红莉,等.γ-干扰素释放试验在结核诊断中的价值[J].临床荟萃,2017,32(6):507-510.
[9] 王俊,戴亚新,刘君,等.胸水γ干扰素特异性效应T细胞检测对结核性胸膜炎诊断的价值评估[J].中国实验诊断学,2018,22(3):430-432.
[10] 庄妍,赖雁平.结核T细胞斑点试验在结核性胸膜炎中的价值[J].天津医科大学学报,2015,21(4):335-338.
[11] 李娜,邱珊,李惠玲,等.干扰素体外释放酶联免疫检验技术在结核病临床诊断中的应用[J].中国卫生检验杂志,2017,27(12):1770-1772.
[12] 曹奇峰,杨卫琴,瞿美君.外周血联合胸腔积液应用T SPOT-TB检测对于诊断结核性胸膜炎的临床研究[J].现代实用医学,2015,27(12):1588-1590.
[13] 刘涛.T-SPOT.TB技术在结核性胸膜炎诊断中的意义[J].国际检验医学杂志,2015,36(9):1283-1284.
[14] 石瑞如,张曼林,韩云港,等.胸水中干扰素释放测定在结核性胸膜炎诊断中的价值[J].中华生物医学工程杂志,2013,19(4):324-326.
[15] 中华人民共和国国家卫生和计划生育委员会.WS 288—2017肺结核诊断[S].北京:中国标准出版社,2017.
[16] 任卫聪,聂理会,姜晓颖,等.γ-干扰素诱导蛋白10在结核性胸膜炎辅助诊断中的应用价值[J].中国防痨杂志,2013,35(2):108-110.
[17] 高鸣,李丽雅,邓西子,等.γ-干扰素释放试验在广州地区艾滋病合并疑似结核人群中的诊断价值[J].热带医学杂志,2017,17(9):1137-1140.
[18] 李月翠,周晶,李成行,等.结核性与癌性胸腔积液的鉴别诊断[J].中华医院感染学杂志,2014,19(24):4787- 4789.
[19] Carrèrekremer S,Rubbo PA,Pisoni A,et al.High IFN-γ release and impaired capacity of multi-cytokine secretion in IGRA supernatants are associated with active tuberculosis[J].PLoS ONE,2016,11(9):e0162137.
[20] Tavares SM,Junior Wde L,Lopes ESilva MR.Normal lymphocyte immunophenotype in an elderlypopulation[J].Rev Bras Hematol Hemmterr,2014,36(3):180-183.
[21] 李宝辉,赵光,王道远,等.γ-干扰素释放试验在结核病筛查的价值评估[J].实用医药杂志,2017,34(10):892-895.
[22] 刘媛媛,宝福凯,柳爱华,等.γ-干扰素与结核病关系研究进展[J].中国热带医学,2012,12(10):1275-1281.
[23] Keng LT,Shu CC,Chen JY,et al.Evaluating pleural ADA,ADA2,IFN-γ and IGRA for diagnosing tuberculous pleurisy[J].J Infect,2013,67(4):294-302.
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