卫安娜　邱薇

【摘要】 目的 评估多项指标联合检测对儿童结核病的诊断价值。方法 90例结核病患儿（病例组）和80例非结核病患儿（对照组）， 均进行γ-干扰素释放试验（IGRA）、结核菌素皮肤试验（TST）、血结核抗体（ATA）指标的检测， 分别单独和联合检验， 分析其灵敏度、特异度、阳性似然比、阴性似然比及约登指数。结果 IGRA在儿童结核病中测定阳性似然比为7.56、约登指数为0.66， TST测定阳性似然比为3.16、约登指数为0.54， ATA测定阳性似然比为4.67、约登指数为0.18， 在单一检测的诊断中， IGRA在儿童结核病中测定阳性似然比及约登指数与其他单项检测比较效能较高。在联合检测的诊断中， IGRA+TST的灵敏度为96.67%、阳性似然比为9.67、约登指数为0.87， IGRA+ATA分别为77.78%、6.22、0.65， TST+ATA分别为57.78%、2.10、0.30， IGRA+TST+ATA分别为96.67%、7.73、0.84， IGRA+TST的灵敏度、阳性似然比、约登指数均有所提高， 与其他多项联合检测比较效能最高。结论 IGRA+TST联合检测在儿童结核病的诊断中有较好的临床价值。

【关键词】 结核病；儿童；诊断

DOI：10.14163/j.cnki.11-5547/r.2016.16.003

【Abstract】 Objective To evaluate diagnostic value of joint detection of multiple indexes for children tuberculosis. Methods There were 90 children with tuberculosis （medical group） and 80 children without tuberculosis （control group） receiving interferon gamma release assay （IGRA）， tuberculin skin test （TST） and tuberculosis antibody （ATA） index. Detections were made by single test and combined tests， their sensitivity， specificity， positive likelihood ratio， negative likelihood ratio and Youden index were analyzed. Results In detection of children tuberculosis， IGRA showed positive likelihood ratio as 7.56 and Youden index as 0.66， while TST showed positive likelihood ratio as 3.16 and Youden index as 0.54， and ATA showed positive likelihood ratio as 4.67 and Youden index as 0.18. In diagnosis by single test for children tuberculosis， IGRA had all higher positive likelihood ratio and Youden index than other tests. In diagnosis by combined tests， IGRA+TST had sensitivity as 96.67%， positive likelihood ratio as 9.67 and Youden index as 0.87， which were respectively 77.78%， 6.22 and 0.65 in IGRA+ATA， 57.78%， 2.10 and 0.30 in TST+ATA， and 96.67%， 7.73 and 0.84 in IGRA+TST+ATA. IGRA+TST showed all improved sensitivity， positive likelihood ratio and Youden index， which were the highest in comparison with other combinedtests. Conclusion Combined detection by IGRA+TST shows good clinical value in diagnosis of children tuberculosis.

【Key words】 Tuberculosis； Children； Diagnosis

儿童感染结核分枝杆菌后， 年龄越小越容易进展为结核病， 如未能及早诊断和治疗， 容易进展为重症结核病甚至死亡[1]。据WHO最新报道， 每年至少有55万例儿童患结核病， 每天至少200例儿童死亡[2]。儿童结核病的临床表现常缺乏特异性、痰含菌量少， 早期诊断存在一定困难；快速、简单易用的结核病诊断技术， 对诊断、治疗及预防控制儿童结核病的发展有重要意义。IGRA、TST、ATA等检测方法对于儿童结核病有一定的辅助诊断价值[3， 4]， 为探讨如何合理使用这3种检测方法以达到最佳的效果， 本研究通过对诊断明确的儿童结核病患儿进行回顾性分析， 将IGRA、TST、ATA检测进行对比， 了解其在儿童结核病诊断中的临床意义， 现报告如下。……