胸水γ干扰素释放试验在结核性胸膜炎中诊断价值.docVIP

胸水γ干扰素释放试验在结核性胸膜炎中诊断价值 　　[摘要] 目的 探讨胸水γ干扰素释放试验（IGRA）在结核性胸膜炎中的诊断价值。 方法 选取2015年2月～2016年3月因胸腔积液于徐州市传染病医院就诊的患者84例，其中临床诊断为结核性胸膜炎46例、非结核性胸膜炎38例，分别采集患者外周血进行γ干扰素水平测定，采集胸水进行γ干扰素和腺苷脱氨酶水平测定，以临床诊断结果作为金标准，比较三种检测方式诊断结核性胸膜炎的灵敏度和特异度以及检测结果一致性，利用MedCalc软件比较三种检测方式ROC曲线面积大小。 结果 以临床诊断结果作为金标准，外周血IGRA、胸水IGRA以及腺苷脱氨酶（ADA）检测诊断结核性胸膜炎灵敏度依次为65.22%、89.13%、71.74%，特异度依次为68.42%、94.73%、78.95%。胸水IGRA灵敏度高于为外周血IGRA（χ2=7.466，P = 0.006）和胸水ADA（χ2=4.420，P = 0.036），胸水IGRA特异度高于为外周血IGRA（χ2=8.756，P = 0.003）和胸水ADA（χ2=4.145，P = 0.042）。外周血和胸水IGRA检测结果一致性较差（Kappa=0.167），胸水IGRA和ADA检测结果一致性较好（Kappa=0.572）。外周血IGRA、胸水IGRA以及ADA检测ROC曲线下面积分别为0.753、0.966、0.814。胸水IGRA检测ROC曲线面积明显大于外周血IGRA检测（Z = 3.923，P 0.001）和胸水ADA检测（Z = 2.779，P = 0.005）。 结论 胸水IGRA在结核性胸膜炎中的诊断效能优于另外两种检测方法，胸水IGRA可以推广为临床上快速诊断结核性胸膜炎的辅助手段。 　　[关键词] 结核性胸膜炎；γ干扰素；诊断价值 　　[中图分类号] R521.7 [文献标识码] A [文章编号] 1673-7210（2016）08（a）-0016-04 　　[Abstract] Objective To investigate the diagnostic value of pleural fluid interferon gamma release assay （IGRA） in patients with tuberculous pleurisy. Methods From February 2015 to March 2016， 84 pleural effusion patients in Xuzhou Infectious Disease Hospital were selected， including 46 cases of tuberculous pleurisy， 38 cases of non-tuberculous pleurisy. Peripheral blood were collected to test γ-interferon levels， and pleural fluid were collected to test γ-interferon and adenosine deaminase levels. Taking clinical diagnosis as the gold standard， the sensitivity， specificity and consistency of the test results of the three detection methods were compared， the three ROC curves were compared by MedCalc software. Results According to clinical diagnosis， the sensitivity of peripheral blood IGRA， pleural fluid IGRA and adenosine deaminase （ADA） were 65.22%， 89.13% and 71.74%， the specificity of peripheral blood IGRA， pleural fluid IGRA and ADA were 68.42%， 94.73% and 78.95%. The sensitivity of pleural fluid IGRA was higher than peripheral blood IGRA （χ2=7.466， P = 0.006） and pleural fluid ADA （χ2=4.420， P = 0.036）. The specificity of pleural