胡月红

[摘要]目的研究結核分枝杆菌相关γ-干扰素（TB-IGRA）检测联合结核杆菌脱氧核糖核酸（TB- DNA）、结核抗体（TB-Ab）检测菌阴肺结核患者对阳性检出率的影响。方法选取2019年3月至2020年3月厦门大学附属第一医院菌阴肺结核疑似患者158例，均行 TB-IGRA、TB-DNA、TB-Ab 检测，以组织培养及病理检查为“金标准”，统计 TB-IGRA、TB-DNA、TB-Ab 单一检测、两两结合、三者联合检测菌阴肺结核阳性的诊断结果，并比较诊断效能（灵敏度、特异度、准确度）。结果 TB-IGRA 检测肺结核真阳性81例，真阴性31例;TB-DNA 检测真阳性60例，真阴性36例;TB-Ab 检测真阳性73例，真阴性30例;TB-IGRA + TB-DNA 检测真阳性91例，真阴性27例;TB-IGRA + TB-Ab 检测真阳性87例，真阴性29例;TB-DNA + TB-Ab 检测真阳性95例，真阴性28例;TB-IGRA、TB-DNA 及 TB-Ab 三者联合检测肺结核真阳性108例，真阴性25例;TB-IGRA 检测肺结核灵敏度略高于 TB-DNA、TB-Ab 检测（ P <0.05）;三者联合诊断的灵敏度、准确度高于两两联合诊断，而两两联合诊断的灵敏度、准确度高于 TB-IGRA、TB-DNA、TB-Ab 单一检测，差异有统计学意义（ P <0.05）。结论 TB-IGRA、TB-DNA、 TB-Ab 三种方法联合检测能提高菌阴肺结核患者诊断效能，有助于临床合理治疗方案的制订，具有良好应用价值。

[关键词]结核分枝杆菌相关γ-干扰素检测;结核杆菌 DNA 检测;结核抗体检测;菌阴肺结核;阳性检出率

[中图分类号] R521; R446.6  [文献标识码] A   [文章编号]2095-0616（2021）23-0146-05

Influence of Mycobacterium tuberculosis-related interferon-γ detection combined with Mycobacterium tuberculosis DNA and tuberculosis antibody detection on positive detection rate of bacterial negative pulmonary tuberculosis

HU  Yuehong

The First Affiliated Hospital of Xiamen University， Fujian， Xiamen 361003， China

[Abstract] Objective To study the influence of Mycobacterium tuberculosis-related interferon-γ（TB-IGRA） detection combined with Mycobacterium tuberculosis deoxyribonucleic acid （TB-DNA） and Tuberculosis antibody （TB-Ab） detection on the positive detection rate of patients with bacterial negative pulmonary tuberculosis （PTB）. Methods A total of 158 suspected patients with bacterial negative PTB in the First Affiliated Hospital of Xiamen University from March 2019 to March 2020 were selected and they were detected for TB-IGRA， TB-DNA and TB-Ab. Taking tissue culture and pathological examination as the "gold standard"， the diagnostic results of single detection， pairwise detection and combined detection of TB-IGRA， TB-DNA and TB-Ab were counted， and the diagnostic efficiency （sensitivity， specificity and accuracy） were compared. Results TB-IGRA detection showed that 81 cases were true positive and 31 cases were true negative. TB-DNA detection informed us of true positive in 60 cases and true negative in 36 cases. TB-Ab detection demonstrated that 73 cases was true positive and 30 cases was true negative. TB-IGRA + TB-DNA detection showed positive in 91 cases and negative in 27 cases. TB-IGRA + TB-Ab detection showed true positive in 87 cases and true negative in 29 cases. TB-DNA + TB-Ab showed true positive in 95 cases and true negative in 28 cases. TB-IGRA， TB-DNA and TB-Ab were combined to detect 108 cases of true positive and 25 cases of true negative PTB. TB-IGRA was slightly more sensitive than TB-DNA and TB-Ab （P <0.05）. The sensitivity and accuracy of the combined diagnosis of the three methods were higher than those of the combined diagnosis of pairwise detection， while the sensitivity and accuracy of the combined diagnosis of pairwise detectionwere higher than those of TB-IGRA， TB-DNA and TB-Ab alone， with statistically significant differences （P <0.05）. Conclusion The combined detection of TB-IGRA， TB-DNA and TB-Ab can improve the diagnostic efficiency of patients with bacterial negative PTB， and contribute to the formulation of rational clinical treatment plan， which has good application value.

[Key words] Detection of Mycobacterium tuberculosis related interferon-γ; Tuberculosis DNA detection; Tuberculosis antibody detection; bacterial negative pulmonary tuberculosis; Positive detection rate

肺结核是临床常见慢性传染疾病，在全球范围内特别是发展中国家具有较高发病率，我国结核病新发患者近88.9万，发病率为63/10万，临床诊治关键是早期准确诊断与隔离治疗[1]。而对于三次痰涂片与一次培养均为阴性的菌阴肺结核临床诊断难度较大，极易出现误诊漏诊情况，因此寻求更准确方法以快速早期诊断结核病对其防治效果具有重要意义[2]。实验室检测指标对肺结核诊断具有重要意义，其中结核分枝杆菌相关γ-干扰素（TB- IGRA）是通过检测受结核分枝杆菌特异性抗原刺激而活化的效应 T 细胞来诊断结核感染，可用于结核分枝杆菌活动感染或潜伏感染的辅助诊断[3]。……