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结核分枝杆菌7?干扰素体外释放试验(TB-IGRA)对结核性胸腔积液的诊断价值

【摘要】目的探讨结核分枝杆菌(MTB)Y-干扰素体外释放试验(TB-IGRA)在疑似MTB感染体胸腔积液患者快速诊断中的应用价值。方法疑似MTB感染伴胸腔积液患者138例，应用TB-IGRA定量检测外周血淋巴细胞分泌Y-干扰素的水平。利用MTBDNA法检测胸腔积液中的MTB，同时用免疫金标法检测血清MTB抗体，并进行统计学分析。结果138例疑似患者经过痰和胸腹水抗酸染色镜检，痰液和胸腹水MTB培养，结核菌素皮肤试验，MTBDNA和MTB抗体等试验确诊结核病患者48例，阳性检出率34.8%，TB-IGRA的阳性检出率为32.6%，MTBDNA的阳性检出率为13.8%，血清MTB抗体的阳性检出率为10.1%。对已确诊的48例结核病患者进行数据分析，TB-IGRA，MTBDNA和血清MTB抗体的准确率分别为93.8%，39.6%，29.1%。据统计分析可知，TB-IGRA的阳性检出率和准确率均显著高于其他2种方法(P0.05)。TB-IGRA对疑似MTB感染的胸腔积液患者诊断的阳性预测值为93.3%，阴性预测值为93.6%。结论TB-IGRA对疑似MTB感染伴胸腔积液患者的诊断具有快速，高敏感性高特异性的优点，优于MTBDNA和血清MTB抗体试验，可以作一种新的技术用于人体MTB感染的诊断。

【关键词】y-干扰素释放试验；结核分枝杆菌；DNA；抗体；胸腔积液

EvaluationofthevalueofTB-IGRAtestinmycobacteriumtuberculosisinfectofpatientswithpleuraleffusion

[AbstraetJobjectiveToinvestigatetheapplicationsignificanceofmycobacteriumtuberculosisIFN-rreleaseassay(TB-IGRA)intherapiddiagnosisforsuspectedMTBinfectedpatientswithpleuraleffusion.MethodsThe138patientswithpleuraleffusionwhichweresuspectedashavingsuspectedMTBinfectionwereenrolled.TB-IGRAwasusedtodeterminethelevelofIFN-rofperipheralbloodlymphocyte.TheMTBDNAmethodwastodetectMTBinpleuraleffusion,meanwhileserumanti-MTBantibobywasdetectedbyimmunogoldfiltrationassay,andtheresultswerediagnosedastuberculosisbysputum,pleuraleffusionandascitessmeartest,sputum,pleuraleffusionandascitesMTBculture,tuberculinskintest,MTBDNAmethodandanti-MTBantibodytest,andthepositiveratewas34.8%.ThepositivetypeofTB-IGRAinthe138patientswithpleuraleffusionwas32.6%,ThepositiverateofMTBDNAmethodwas13.8%,andthepositiverafeofanti-MTBantibodytestwas10.1%.Thedateof48patientswithtuberculosiswereanalyzed.TB-IGRAhadtheconsistencyrateof93.8%,whiletheconsistencyratesofMTBDNAmethodandanti-MTBantibodytestwere39.6%and29.1%respectively.ThepositiverateandconsistencyrateofTB-IGRAweresignifica