γ―干扰素释放试验荧光定量PCR结核菌素皮肤试验联合检测对涂阴性肺结核诊断价值.docVIP

γ―干扰素释放试验荧光定量PCR结核菌素皮肤试验联合检测对涂阴性肺结核诊断价值 　　【摘要】 目的：研究γ-干扰素释放试?（IGRA）、荧光定量PCR（FQ-PCR）、结核菌素皮肤试验（TST）三种方法联合检测对涂阴性肺结核的诊断价值。方法：选取确诊的33例涂阴性肺结核和30例非结核的肺部感染患者，分别使用酶联免疫法（ELISA法），测定患者全血干扰素的浓度，荧光定量PCR法检测患者肺泡灌洗液的结核杆菌DNA，卡介菌纯蛋白衍生物（BCG-PPD）进行结核菌素皮肤试验。结果：γ-干扰素释放试验、荧光定量PCR、结核菌素皮肤试验三种检测方法在肺结核组和非肺结核组的阳性率比较，差异均有统计学意义（P0.05）；三种检测方法在肺结核组的阳性率比较，差异有统计学意义（P0.05）。γ-干扰素释放试验方法的灵敏度为84.85%，特异度为86.67%，Youden指数为0.72；荧光定量PCR方法的灵敏度为60.61%，特异度为83.33%，Youden指数为0.44；结核菌素皮肤试验的灵敏度为81.82%，特异度为53.33%，Youden指数为0.35。联合检测试验中以IGRA平行联合FQ-PCR（Youden指数为0.66）和IGRA系列联合TST（Youden指数为0.63）的诊断效能最好。结论：γ-干扰素释放试验较荧光定量PCR、结核菌素皮肤试验对涂阴性肺结核有更好的诊断价值，联合检测试验以IGRA平行联合FQ-PCR诊断价值最佳。 　　【关键词】 干扰素释放试验； 荧光定量PCR； 结核菌素试验； 涂阴性肺结核； 诊断价值 　　【Abstract】 Objective：To study the diagnostic value of the combination of interferon gamma release assay （IGRA），fluorescence quantitative PCR （FQ-PCR） and tuberculin skin test （TST） for the diagnosis of smear negative pulmonary tuberculosis.Method：Thirty-three patients diagnosed smear negative pulmonary tuberculosis and 30 cases of no tuberculosis were detected by using three ways，the IGRA was completed by detecting the patient of concentration of blood interferon with using ELISA；mycobacterium tuberculosis DNA was measured in bronchoalveolar lavage fluid by using fluorescent quantitative PCR；the tuberculin skin test was achieved by using Purified Protein Derivative of BCG （BCG-PPD）.Result：The IGRA，FQ-PCR，TST were significant differences in positive rate of pulmonary tuberculosis group and non tuberculosis group（P0.05）；and the positive rate of the three detection methods were significant differences in pulmonary tuberculosis group too（P0.05）.The sensitivity of interferon gamma release assay was 84.85%，the specificity was 86.67%，the Youden index was 0.72；the sensitivity of fluorescence quantitative PCR was 60.61%，the specificity was 83.33%，the Youden index was 0.44；the sensitivity of TST was 81.82%，the specificity was 53.33%，the Youden index was 0.35.The diagnostic efficacy of the IGRA parallel connecte