γ-干扰素释放试验（IGRA）在发热患者中结核菌感染诊断价值的探讨

发布时间：2018-05-21 06:11

  本文选题：γ-干扰素释放试验(IGRA) + 发热　； 参考：《吉林大学》2014年硕士论文

【摘要】：背景：临床上很多发热患者病因诊断比较困难，感染性疾病是发热的主要原因，我国发热的患者中结核菌感染患者可能较多。非结核病若误诊为结核病，应用抗结核药物后可引起肝、肾损害；结核病一旦漏诊则会延误病情，若因为其他原因需要应用激素类药物而未进行抗结核治疗则可能引起结核菌感染播散。为避免过度治疗或延误病情，早期正确诊断和及时控制结核菌感染都有极其重要意义。对于那些临床上没有明确结核感染灶的发热患者，目前的技术对于结核菌感染的诊断比较困难。T-SPOT.TB于2008年成为FDA认证的第四个γ-干扰素释放试验（IGRA），许多国内外研究均提示T-SPOT.TB检测在诊断结核病与潜伏性结核方面有较高的敏感度和特异度，但在发热患者中结核菌感染诊断的敏感度和特异度罕有报道。 目的：对于无明确结核感染灶的发热患者结核菌感染的诊断比较困难，IGRA作为结核菌感染体外免疫检测的新方法，近几年在临床上得到广泛应用。本研究对发热患者进行T-SPOT.TB检测，并对该检测在发热患者中的应用价值进行探讨。 方法：以456例发热患者作为研究对象，所有患者在进行相关检查后没有明确发热原因，或不除外结核菌感染，进行T-SPOT.TB检测。采用SPSS17.0统计软件，对患者的临床诊断和T-SPOT.TB检测结果进行分析。 结果： 1.456例患者中T-SPOT.TB检测阳性为203例(203/456，44.5%)，T.SPOT-TB检测可疑阳性为21例(21/456，4.6%)，T-SPOT.TB检测阴性为232例(232/456，50.9%)。 2. T-SPOT.TB检测阳性与阴性组之间在年龄、既往有无结核病史方面均无显著性差异，但在患者性别方面有统计学意义，T-SPOT.TB检测阳性组中男性患者多于女性。 3.本研究中有85例患者临床诊断为结核病例（其中肺内结核34例，结核菌感染24例，结核性胸膜炎10例，其他部位结核17例），371例患者无明确结核菌感染证据（其中42例疑似结核病例，329例非结核病例）。 4. T-SPOT.TB检测在发热患者中诊断结核菌感染的敏感度较高，为84.3%，阴性预测值达94.2%，特异度为68.1%，阳性预测值为41.4%，Kappa值为0.380，ROC曲线下面积为0.762（95%CI：70.7%-81.7%）。在FUO中诊断结核的敏感度为85.5%，阴性预测值达90.9%，特异度为60.6%，，阳性预测值为47.5%，Kappa值为0.373，ROC曲线下面积为0.730（95%CI：65.4%-80.6%）。 5．T-SPOT.TB检测在肺内、肺外结核的敏感度分别为78.1%、88.2%，阴性预测值分别为92.6%、95.3%，Kappa值分别为0.299、0.438，ROC曲线下面积分别为0.719（95%CI：62.3%-81.5%）、0.791（95%CI：72.4%-85.7%）。 6.在329例非结核病例中有99例T-SPOT.TB检测阳性。 结论： 1. T-SPOT.TB检测结果不受既往结核病史影响。 2. T-SPOT.TB因其有较高的阴性预测值，对排除结核菌感染有重要意义。 3. T-SPOT.TB检测可作为结核病、结核菌感染诊断的辅助工具，尤其是肺外结核。 4.应用T-SPOT.TB可以在发热患者中发现那些无明确结核感染灶的结核菌感染者，尤其是那些需要定期随访的潜伏性结核感染者。
[Abstract]:Background: the etiology of many patients with fever is difficult to diagnose. Infectious disease is the main cause of fever. There may be more tuberculosis infection in the patients with fever in our country. If non tuberculosis is misdiagnosed as tuberculosis, the application of anti tuberculosis drugs can cause liver and kidney damage; once the disease is missed, the disease will delay the disease, if because of the others The reason for the need to use hormone drugs without anti tuberculosis treatment may cause tuberculosis infection to spread. It is of great significance to avoid excessive treatment or delay the disease, early correct diagnosis and timely control of tuberculosis infection. For those with no definite tuberculosis infection, the current technology is for tuberculosis. The diagnosis of bacterial infection is relatively difficult.T-SPOT.TB became the fourth FDA certified interferon release test (IGRA) in 2008. Many domestic and foreign studies have suggested that T-SPOT.TB detection has high sensitivity and specificity in the diagnosis of tuberculosis and latent tuberculosis, but the sensitivity and specificity of the diagnosis of tuberculosis infection in fever patients are rare. There is a report.
Objective: the diagnosis of tuberculosis infection in fever patients with no definite tuberculosis infection is difficult. IGRA is a new method for the detection of Mycobacterium tuberculosis in vitro, and it has been widely used clinically in recent years. This study was used to detect T-SPOT.TB in patients with fever and to explore the application value of this test in fever patients.
Methods: 456 cases of fever patients were taken as the research object. All the patients did not have a definite cause of fever after the related examination, or did not exclude Mycobacterium tuberculosis, and carried out T-SPOT.TB detection. The SPSS17.0 statistical software was used to analyze the clinical diagnosis of the patients and the results of T-SPOT.TB detection.
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