[1]何莉,赵希唯,陈刚,等.γ-干扰素释放试验在不同类型肺结核中的应用价值[J].第三军医大学学报,2017,39(20):2017-2021.
 HE Li,ZHAO Xiwei,CHEN Gang,et al.Value of interferon-gamma release assay in pulmonary tuberculosis[J].J Third Mil Med Univ,2017,39(20):2017-2021.
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γ-干扰素释放试验在不同类型肺结核中的应用价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第20期
页码:
2017-2021
栏目:
临床医学
出版日期:
2017-10-30

文章信息/Info

Title:
Value of interferon-gamma release assay in pulmonary tuberculosis
作者:
何莉赵希唯陈刚杜先智
重庆医科大学附属第二医院呼吸内科; 400020 重庆,重庆市人民医院呼吸内科
Author(s):
HE Li ZHAO Xiwei CHEN Gang DU Xianzhi

Department of Respiratory Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010; Department of Respiratory Diseases, the People’s Hospital of Chongqing, Chongqing, 400020, China

关键词:
&gamma-干扰素释放试验肺结核
Keywords:
interferon-gamma release assay pulmonary tuberculosis
分类号:
R181.32; R521; R977.6
文献标志码:
A
摘要:

目的    探讨γ-干扰素释放试验(interferon-gamma release assay,IGRA)在不同类型肺结核中的应用价值。方法    收集2015-2016年于我院及重庆市人民医院1 449例住院患者,分析和比较IGRA在肺结核、活动性肺结核、陈旧性肺结核、特殊人群肺结核、其他肺病中的灵敏度。结果    IGRA对肺结核的灵敏度为84.4%,与其他肺病组比较差异有统计学意义(P<0.05);其对活动性肺结核灵敏度(85.6%)与陈旧性肺结核(79.7%)比较差异无统计学意义(P>0.05);菌阳肺结核、菌阴肺.核的灵敏度分别为85.1%、86.6%,两组比较差异无统计学意义(P>0.05);其中痰涂片阳性但IGRA阴性者25例,菌种鉴定为结核分枝杆菌20例(80%),非结核分枝杆菌5例(20%);4例孕妇合并肺结核IGRA均阳性(100%)。结论     ①单用IGRA不能鉴别陈旧性肺结核与活动性肺结核,应联合其他检测手段;②若菌阳但IGRA阴性的肺疾病患者要考虑病原菌为非结核分枝杆菌的可能,应进一步行分枝杆菌菌种鉴定;③既往无结核病史的特殊人群(如孕妇)IGRA阳性有利于辅助诊断活动性结核病。

Abstract:

[1]YEW W W, LEUNG C C. Update in tuberculosis 2007[J]. Am J Respir Crit Care Med, 2008, 177(5): 479-485. DOI: 10.1164/rccm.200710-1561UP.
[2]陆恩词, 朱颖蔚. T-SPOT.TB在肺结核合并糖尿病患者诊断中的价值[J]. 山西医科大学学报, 2015, 46(4): 334-336. DOI: 10.13753/j.issn.1007-6611.2015.04.014.
LU E C, ZHU Y W. Diagnostic value of tspot.tb in patients with diabetes combined with pulmonary tuberculosis[J]. J Shanxi Med Univ, 2015, 46(4): 334-336. DOI: 10.13753/j.issn.1007-6611.2015.04.014.
[3]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会. γ-干扰素释放试验在中国应用的建议[J]. 中华结核和呼吸杂志, 2014, 37(10): 744-747. DOI: 10.3760/cma.j.issn.1001-0939.2014.10.011.
Chinese Society for Tuberculosis of Chinese Medical Association, Editorial Board of Chin J Tuberc Respir Dis. Proposal of interferon gamma release assay in China[J]. Chin J Tuberc Respir Dis, 2014, 37(10): 744-747.  DOI: 10.3760/ cma.j.issn.1001-0939.2014.10.011.
[4]LALVANI A, PAREEK M. Interferon gamma release assays: principles and practice [J]. Enferm Infecc Microbiol Clin, 2010, 28(4): 245-252. DOI: 10.1016/j.eimc.2009.05.012.
[5]DE KEYSER E, DE KEYSER F, DE BAETS F. Tuberculin skin test versus interferongamma release assays for the diagnosis of tuberculosis infection [J]. Acta Clin Belg, 2014,69(5): 358-366. DOI: 10.1179/2295333714Y.0000000043.
[6]DIEL R, LODDENKEMPER R, NIENHAUS A. Evidencebased comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis[J]. Chest, 2010, 137(4): 952-968. DOI: 10.1378/chest.092350.
[7]LU P, CHEN X, ZHU L M, et al. Interferon-gamma release assays for the diagnosis of tuberculosis: a systematic review and metaanalysis[J]. Lung, 2016, 194(3): 447-458. DOI: 10.1007/s00408-016-9872-5.
[8]刘佳庆, 张立, 孙海柏, 等. γ干扰素释放试验在肺结核早期诊断中的应用[J]. 山东医药, 2013, 53(3): 82-84. DOI: 10.3969/j.issn.1002-266X.2013.03.033.
LIU J Q, ZHANG L, SUN H B, et al. Application of interferon-γ release test in early diagnosis of pulmonary[J]. Shandong Med J, 2013, 53(3): 82-84. DOI: 10.3969/j.issn.1002 266X.2013.03.033.
[9]DHEDA K, POORAN A, PAI M, et al. Interpretation of mycobacterium tuberculosis antigenspecific IFNgamma release assays (TSPOT.TB) and factors that may modulate test results[J]. J Infect, 2007, 55(2): 169-173. DOI: 10.1016/ j.jinf.2007.02.005.
[10]张腊红, 洪理泉, 罗贤, 等. 结核分枝杆菌相关IFN-γ释放试验在结核病诊断及疗效监测中的应用[J]. 放射免疫学杂志, 2013, 26(6): 760-764. DOI: 10.3969/j.issn.1008- 9810.2013.06.039.
ZHANG L H, HONG L Q, LUO X, et al. Application of mycobacterium tuberculosis specific protein interferongamma release assay in tuberculosis diagnosis and therapeutic monitoring[J]. J Radioimmunol, 2013, 26(6): 760-764. DOI: 10.3969/j.issn.1008-9810.2013.06.039.
[11]DRUSZCZYNSKA M, WLODARCZYK M, KIELNIEROWSKI G, et al. Two-year follow-up study of mycobacterium tuberculosis antigendriven IFNγ responses and macrophage sCD14 levels after tuberculosis contact[J]. Indian J Microbiol,2016, 56(2): 205-213. DOI: 10.1007/ s12088-016-0571-y.
[12]周文, 张鹏, 宋世辉, 等. 300例肺癌患者淋巴细胞计数结果分析[J]. 中国肺癌杂志, 2009, 12(10): 1127-1129. DOI: 10. 3779/ j. issn. 1009-3419.2009.10.15.
ZHOU W, ZHANG P, SONG S H, et al. Analysis of lymphocyte count in 300 lung cancer patients[J]. Chin J Lung Cancer, 2009, 12(10): 1127-1129. DOI: 10.3779/ j. issn.1009-3419.2009.10.15.
[13]LIGHTERFISHER J, SURETTE A M. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy[J]. Obstet Gynecol, 2012, 119(6): 1088-1095. DOI: 10.1097/AOG. 0b013e3182546aff.
[14]施正雄, 代冬梅, 许汪斌, 等. 结核患者终止妊娠后反生免疫恢复性疾病1例报道[J]. 安徽医药, 2013, 17(7): 1205-1206. DOI:  10.3969/ j. issn. 10096469. 2013. 07. 053.
SHI Z X, DAI D M, XU W B, et al. A case report of tuberculosis patients with postpregnancy anti-immune recovery disease[J]. Anhui Med Pharma J, 2013, 17(7): 1205-1206. DOI: 10.3969/j.issn.10096469.2013.07.053.

参考文献/References:

[1]YEW W W, LEUNG C C. Update in tuberculosis 2007[J]. Am J Respir Crit Care Med, 2008, 177(5): 479-485. DOI: 10.1164/rccm.200710-1561UP.
[2]陆恩词, 朱颖蔚. T-SPOT.TB在肺结核合并糖尿病患者诊断中的价值[J]. 山西医科大学学报, 2015, 46(4): 334-336. DOI: 10.13753/j.issn.1007-6611.2015.04.014.
LU E C, ZHU Y W. Diagnostic value of tspot.tb in patients with diabetes combined with pulmonary tuberculosis[J]. J Shanxi Med Univ, 2015, 46(4): 334-336. DOI: 10.13753/j.issn.1007-6611.2015.04.014.
[3]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会. γ-干扰素释放试验在中国应用的建议[J]. 中华结核和呼吸杂志, 2014, 37(10): 744-747. DOI: 10.3760/cma.j.issn.1001-0939.2014.10.011.
Chinese Society for Tuberculosis of Chinese Medical Association, Editorial Board of Chin J Tuberc Respir Dis. Proposal of interferon gamma release assay in China[J]. Chin J Tuberc Respir Dis, 2014, 37(10): 744-747.  DOI: 10.3760/ cma.j.issn.1001-0939.2014.10.011.
[4]LALVANI A, PAREEK M. Interferon gamma release assays: principles and practice [J]. Enferm Infecc Microbiol Clin, 2010, 28(4): 245-252. DOI: 10.1016/j.eimc.2009.05.012.
[5]DE KEYSER E, DE KEYSER F, DE BAETS F. Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection [J]. Acta Clin Belg, 2014,69(5): 358-366. DOI: 10.1179/2295333714Y.0000000043.
[6]DIEL R, LODDENKEMPER R, NIENHAUS A. Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis[J]. Chest, 2010, 137(4): 952-968. DOI: 10.1378/chest.092350.
[7]LU P, CHEN X, ZHU L M, et al. Interferongamma release assays for the diagnosis of tuberculosis: a systematic review and metaanalysis[J]. Lung, 2016, 194(3): 447-458. DOI: 10.1007/s00408-016-9872-5.
[8]刘佳庆, 张立, 孙海柏, 等. γ干扰素释放试验在肺结核早期诊断中的应用[J]. 山东医药, 2013, 53(3): 82-84. DOI: 10.3969/j.issn.1002-266X.2013.03.033.
LIU J Q, ZHANG L, SUN H B, et al. Application of interferon-γ release test in early diagnosis of pulmonary[J]. Shandong Med J, 2013, 53(3): 82-84. DOI: 10.3969/j.issn.1002- 266X.2013.03.033.
[9]DHEDA K, POORAN A, PAI M, et al. Interpretation of mycobacterium tuberculosis antigen-specific IFNgamma release assays (T-SPOT.TB) and factors that may modulate test results[J]. J Infect, 2007, 55(2): 169-173. DOI: 10.1016/ j.jinf.2007.02.005.
[10]张腊红, 洪理泉, 罗贤, 等. 结核分枝杆菌相关IFNγ释放试验在结核病诊断及疗效监测中的应用[J]. 放射免疫学杂志, 2013, 26(6): 760-764. DOI: 10.3969/j.issn.1008 9810.2013.06.039.
ZHANG L H, HONG L Q, LUO X, et al. Application of mycobacterium tuberculosis specific protein interferongamma release assay in tuberculosis diagnosis and therapeutic monitoring[J]. J Radioimmunol, 2013, 26(6): 760-764. DOI: 10.3969/j.issn.1008-9810.2013.06.039.
[11]DRUSZCZYNSKA M, WLODARCZYK M, KIELNIEROWSKI G, et al. Two-year follow-up study of mycobacterium tuberculosis antigen-driven IFN-γ responses and macrophage sCD14 levels after tuberculosis contact[J]. Indian J Microbiol,2016, 56(2): 205-213. DOI: 10.1007/ s12088-016-0571-y.
[12]周文, 张鹏, 宋世辉, 等. 300例肺癌患者淋巴细胞计数结果分析[J]. 中国肺癌杂志, 2009, 12(10): 1127-1129. DOI: 10. 3779/ j. issn. 1009-3419.2009.10.15.
ZHOU W, ZHANG P, SONG S H, et al. Analysis of lymphocyte count in 300 lung cancer patients[J]. Chin J Lung Cancer, 2009, 12(10): 1127-1129. DOI: 10.3779/ j. issn.10093419.2009.10.15.
[13]LIGHTERFISHER J, SURETTE A M. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy[J]. Obstet Gynecol, 2012, 119(6): 1088-1095. DOI: 10.1097/AOG. 0b013e3182546aff.
[14]施正雄, 代冬梅, 许汪斌, 等. 结核患者终止妊娠后反生免疫恢复性疾病1例报道[J]. 安徽医药, 2013, 17(7): 1205-1206. DOI:  10.3969/ j. issn. 10096469. 2013. 07. 053.
SHI Z X, DAI D M, XU W B, et al. A case report of tuberculosis patients with post-pregnancy anti-immune recovery disease[J]. Anhui Med Pharma J, 2013, 17(7): 1205-1206. DOI: 10.3969/j.issn.1009-6469.2013.07.053.

更新日期/Last Update: 2017-10-25