摘要
目的探讨分析多种免疫学检测方法在肺结核与肺外结核诊断中的应用价值。方法回顾性纳入2012年5月至2017年5月期间苏州大学附属传染病医院门诊住院结核病病例240例,按WS196-2017标准分肺外结核组74例与肺结核组166例,非结核肺部疾病95例。分析γ干扰素释放试验(IGRAs),蛋白芯片(16KD、38KD、LAM抗体)检测,结核抗体(IgG、IgM抗体)检测结果及效能。结果IGRAs检测在结核病组与其他肺部疾病组中的阳性率分别为90.8%,38.9%组间具有统计学差异(χ^2=95.648,P<0.001)。38KD和LAM检测在结核病中阳性率均高于其他肺部疾病组,组间比较差异具有统计学意义(χ^2=21.344和24.404,P<0.001);在肺外结核组的阳性率均高于肺结核组,组间具有统计学显著性差异(χ^2=7.79和5.55,P<0.05),而IGRAs、16KD、IgG和IgM检测的阳性率在肺结核组与肺外结核组间无统计学显著性差异(P>0.05)。IGRAs检测在肺结核组与肺外结核组中的灵敏度(89.16%、93.24%)、准确性(50.21%、54.3%)均明显高于其他检测方法。其在肺结核组和肺外结核组中的AUC(0.751和0.771)均为最大。6KD、38KD、LAM、IgG、IgM这五种检测方法在肺结核中的特异度(97.89%、85.26%、85.26%、83.16%、64.21%、98.95%)均高于IGRAS检测的特异度(61.05%),而其灵敏度、准确性均远低于IGRAs检测。16KD、38KD、LAM、IgG检测在肺结核中的灵敏度(3.01%、36.14%、40.36%、50.00%)和准确性(0.90%、21.4%、23.52%、14.21%)均低于在肺外结核中的灵敏度(5.41%、55.41%、56.76%、52.70%)和准确性(3.30%、40.64%、39.92%、16.91%),其中38KD与LAM检测在肺外结核中的灵敏度明显高于其在肺结核中的灵敏度。在肺结核中16KD的准确性(0.90%)与AUC(0.505)均最小,诊断效能较低;在肺外结核中IgM的准确性(1.65%)与AUC(0.508)均最小,诊断效能较低。几种联合检测中,IGRAs+38KD+LAM+IgG+IgM组合在肺结核中的灵敏度(96.4%)、特异度(64.2%)、准确性(60.60%)、AUC(0.7
Objective To explore and analyze the application value of various immunological detection methods in diagnosis of tuberculosis and extra-pulmonary tuberculosis.Methods A retrospective study of 240 outpatients with tuberculosis from May 2012 to May 2017 was conducted.According to the WS196-2017 criteria,there were 74 cases of extra-pulmonary tuberculosis and 166 cases of pulmonary tuberculosis and 95 cases of non-tuberculous pulmonary diseases.The results of interferon gamma release assay(IGRAs),protein chip(16KD,38KD,LAM antibody)and tuberculosis antibody(IgG,IgM antibody)were analyzed.Results The positive rate of IGRAs was 90.8% in the tuberculosis group and 38.9% in the other pulmonary diseases group, respectively (χ^2=95.648, P< 0.001). The positive rate of 38KD and LAM in tuberculosis were higher than those in the other pulmonary disease groups (χ^2=21.344 and 24.404, P< 0.001). The positive rate of 38KD and LAM in the extra-pulmonary tuberculosis group was higher than those in the pulmonary tuberculosis group (χ^2=7.79 and 5.55, P< 0.05), while the positive rate of IGRAs, 16KD, IgG and IgM was not significantly different between the pulmonary tuberculosis group and the extra-pulmonary tuberculosis group ( P> 0.05). The sensitivity (89.16%, 93.24%) and accuracy (50.21%, 54.3%) of IGRAs in the pulmonary tuberculosis group and the extra-pulmonary tuberculosis group were significantly higher than other detection methods. The AUC (0.751 and 0.771) in the pulmonary tuberculosis group and the extra-pulmonary tuberculosis group were the largest. The specificity (97.89%, 85.26%, 85.26%,83.16%, 64.21%, 98.95%) of the five detection methods of 6KD, 38KD, LAM, IgG and IgM in pulmonary tuberculosis was higher than that of IGRAS (61.05%), and their sensitivity and accuracy were much lower than that of IGRAs. The sensitivity (3.01%, 36.14%, 40.36%, 50.00%) and accuracy (0.90%, 21.4%, 23.52%, 14.21%) of 16KD, 38KD, LAM and IgG detection in pulmonary tuberculosis were lower than those in extra-pulmonary tuberculosis (5.41
作者
殷晓云
朱晓燕
朱捷
陈慧
赵静
张晓龙
胥萍
YIN Xiao-yun;ZHU Xiao-yan;ZHU Jie;CHEN Hui;ZHAO Jing;ZHANG Xiao-long;XU Ping(Infection Hospital Affiliated to Soochow University,Suzhou,Jiangsu 215007,China;Suzhou Center for Disease Control and Prevention,Suzhou,Jianshu 215007,China)
出处
《临床肺科杂志》
2019年第9期1660-1664,共5页
Journal of Clinical Pulmonary Medicine
基金
江苏省科技项目基础研究计划(BK20161230)
苏州市重点病种诊疗项目(LCZX201614)
关键词
结核病分类
IGRAs
蛋白芯片
结核抗体
效能分析
taxonomy of tuberculosis
IGRAs
protein chip
tuberculosis antibody
efficacy analysis
