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目的:探讨全血γ-干扰素释放试验(IGRA)在痰涂片阴性肺结核(PTB)快速诊断中的应用价值。方法:选择可疑PTB患者,均进行IGRA、结核菌素试验(TST)、胸部X线片和高分辨率CT(HRCT)检查,根据最终临床诊断分为PTB组和非PTB组,比较各检测手段单独和联合的诊断效能。结果:共133例患者纳入分析,其中确诊PTB 54例,非PTB 79例,2组首诊症状组间比较差异有统计学意义(P<0.05),PTB组咳痰低于非PTB组,而胸痛、体重下降PTB组高于非PTB组;IGRA敏感度和阴性预测值均高于其他检查方法(P<0.05),特异度、阳性预测值和准确率各检测手段均差异无统计学意义(P<0.05);IGRA与TST、CT联合诊断时敏感度、阳性预测值、阴性预测值和准确率无明显增加,但特异度分别从62.4%下降到36.3%和46.7%(P<0.05);IGRA与TST、CT三者联合检测时,特异度从62.4%下降到27.1%(P<0.05)。结论:IGRA对诊断痰涂片阴性的PTB患者敏感度和阴性预测值均高于其他诊断方法,但与其他方法联合不能提高诊断效能。
Objective: To investigate the value of whole blood γ-interferon release assay (IGRA) in the rapid diagnosis of sputum smear-negative pulmonary tuberculosis (PTB). Methods: Patients with suspicious PTB were selected and examined by IGRA, TST, chest X-ray and high resolution CT (HRCT). According to the final clinical diagnosis, they were divided into PTB group and non-PTB group. Individual and combined diagnostic efficacy. Results: A total of 133 patients were included in the analysis. Among them, 54 cases were diagnosed as PTB and 79 cases were non-PTB. The difference between the two groups was statistically significant (P <0.05). PTB group sputum expectoration was lower than non-PTB group Chest pain and weight loss in PTB group were higher than those in non-PTB group. The sensitivity and negative predictive value of IGRA were higher than those of other methods (P <0.05). There was no significant difference in specificity, positive predictive value and accuracy P <0.05). The sensitivity, positive predictive value, negative predictive value and accuracy of IGRA combined with TST and CT did not increase significantly, but the specificity decreased from 62.4% to 36.3% and 46.7% respectively (P <0.05). When combined with IGST, TST and CT, the specificity decreased from 62.4% to 27.1% (P <0.05). CONCLUSIONS: The sensitivity and negative predictive value of IGRA for PTB patients with negative sputum smear are higher than those of other diagnostic methods, but the combination with other methods can not improve the diagnostic efficacy.