全血γ干扰素释放试验在活动性结核中的诊断价值及其影响因素

发布时间：2018-04-30 07:35

本文选题：全血γ干扰素释放试验 + 活动性结核　；参考：《复旦大学》2014年博士论文

【摘要】：目的：全血γ干扰素释放试验QuantiFERON-TB Gold in-Tube(QFT-GIT)是近年来发展起来的γ干扰素释放试验之一,由于其操作方便,对设备要求低,在国际上被广泛用于辅助活动性结核的诊断,但该试剂盒在国内尚未上市使用,同时年龄、免疫抑制剂或抗结核治疗等因素对检测结果是否有影响仍然存在疑问。本研究比较了在我国这一结核病高发地区,QFT-GIT用于儿童和成人活动性结核的诊断价值,并探讨了激素以及抗结核治疗对其结果的影响。方法：研究入组临床怀疑活动性结核的儿童60名,成人212名,采血进行QFT-GIT检测；同时收集每位患者的临床症状、病原学、病理学、影像学、治疗方案等相关信息,进行诊断分类。比较分析QFT-GIT在儿童和成人中的诊断价值,并探讨检测前接受激素和抗结核治疗对结果的影响。结果：QFT-GIT在儿童中用于诊断活动性结核的灵敏度为83.%(95%CI66.3%-94.6%),特异度为88.5%(95%CI 70.2%-96.8%),阳性预测值为92.9%(95%CI76.5%-99.1%),阴性预测值为82.1%(95%CI 63.1%-93.9%)。在成人中用于诊断活动性结核的灵敏度为73.7%(95%CI 57.8%-85.2%),特异度为70.4%(95%CI62.9%-77.0%),阳性预测值为47.5%(95%CI 35.3%-60.0%),阴性预测值为93.3%(95%CI 87.2%-96.8%)。激素治疗对丝裂原引起的γ干扰素释放会产生抑制作用(P0.05)。在QFT_GIT检测前接受激素治疗的结核患者中,25.0%的儿童出现假阴性结果,28.6%的成人出现不确定结果,而接受抗结核治疗的成人结核患者,有44.4%出现假阴性结果。同时研究还发现,无论在儿童还是成人中,活动性结核患者的丝裂原引起的γ干扰素释放水平均较非活动性结核患者低。结论：QFT-GIT在儿童中用于诊断活动性结核的灵敏度和特异度均高于成人。激素治疗对儿童和成人的检测结果存在负面影响,抗结核治疗会降低检测方法的灵敏度。因此,我们推荐在抗结核治疗开始前进行QFT-GIT检测,并且避免使用于接受过免疫抑制剂如激素治疗的患者。QFT-GIT检测结果的定量分析,对于监测疾病进展过程中机体结核特异性和非特异性免疫水平有重要参考价值。
[Abstract]:Objective: the whole blood interferon 纬 release test (QuantiFERON-TB Gold in-Tubeus QFT-GITT) is one of the developed interferon 纬 release tests in recent years. Because of its convenient operation and low requirements for equipment, it has been widely used in the international diagnosis of active tuberculosis. However, the kit is not yet available in China, and there are still questions about whether age, immunosuppressant or antituberculous therapy have any effect on the test results. This study compared the diagnostic value of QFT-GIT for active tuberculosis in children and adults in this high incidence area of tuberculosis in China, and discussed the effect of hormone and antituberculous therapy on the results. Methods: blood samples were collected from 60 children and 212 adults with suspected active tuberculosis, and their clinical symptoms, etiology, pathology, imaging and treatment plan were collected. Carry out diagnostic classification. To compare and analyze the diagnostic value of QFT-GIT in children and adults, and to explore the effect of hormone and antituberculous therapy before testing. Results the sensitivity for the diagnosis of active tuberculosis in children was 83.95 and the sensitivity was 83.95 and the accuracy was 88.5%(95%CI 70.2-96.8.The positive predictive value was 92.99-95CI76.5-99.1and the negative predictive value was 82.1%(95%CI 63.1- 93.90.The negative predictive value was 63.1- 93.90.The sensitivity was 70.2-96.80.The positive predictive value was 92.99-95CI76.5-99.1C, and the negative predictive value was 82.1%(95%CI 63.1-93.9B. The sensitivity for diagnosis of active tuberculosis in adults was 73.7%(95%CI 57.8-85.2, the specificity was 70.4 and the CI62.9-77.0, the positive predictive value was 47.5%(95%CI 35.3-60.0 and the negative predictive value was 93.3%(95%CI 87.2 -96.80.The positive predictive value was 47.5%(95%CI 35.3-60.0 and the negative predictive value was 93.3%(95%CI 87.2 -96.80.The positive predictive value was 47.5%(95%CI 35.3- 60.0 and the negative predictive value was 93.3%(95%CI 87.2-96.8. Hormone therapy can inhibit the release of interferon 纬 induced by mitogen. Among the tuberculosis patients who received hormone therapy before QFT_GIT test, 25.0% of children had false negative results and 28.6% of adults had uncertain results, while 44.4% of adult TB patients who received anti-tuberculosis treatment had false negative results. It was also found that the release level of IFN- 纬 in active TB patients was lower than that in non-active TB patients, both in children and adults. Conclusion the sensitivity and specificity of the diagnosis of active tuberculosis in children were higher than those in adults. Hormone therapy has a negative effect on the test results in children and adults, and anti-tuberculosis therapy reduces the sensitivity of the test method. Therefore, we recommend that QFT-GIT tests be performed before the start of anti-TB therapy and avoid quantitative analysis of QFT-GIT results in patients who have been treated with immunosuppressants such as hormones. It has important reference value for monitoring the specific and non-specific immune level of tuberculosis in the process of disease progression.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R52

【相似文献】