摘要
目的评价外周血结核分枝杆菌γ-干扰素体外释放试验(TB-IGRA)对结核性脑膜炎早期辅助诊断的价值。方法收集2015年1—12月四川大学华西医院住院治疗的56例结核性脑膜炎患者(实验组)及56例非结核性脑膜炎患者(对照组)的TB-IGRA、脑脊液结核分枝杆菌培养、脑脊液TB-DNA的检查结果,计算各诊断方法的灵敏度和特异度。结果 TB-IGRA、脑脊液培养、脑脊液TB-DNA诊断结核性脑膜炎的灵敏度分别为87.5%(49/56)、19.6%(11/56)、60.7%(34/56),特异度分别为89.3%(50/56)、100.0%(56/56)、76.8%(43/56)。TBIGRA诊断结核脑膜炎的灵敏度高于脑脊液TB-DNA检查和脑脊液结核分枝杆菌培养,且TB-IGRA特异度高于脑脊液TB-DNA(89.3%>76.8%),三者两两相比,差异均具有统计学意义(均P<0.01)。其中脑脊液培养确诊的11例病例中,有10例TB-IGRA阳性,阳性率为90.9%(10/11);45例临床诊断+抗结核治疗有效的病例中,TB-IGRA阳性39例,阳性率为86.7%(39/45)。结论 TB-IGRA协助结核性脑膜炎患者的早期诊断具有高灵敏度和特异度,其检查方便、快速、有效,值得临床推广。
Objective To evaluate the value of peripheral blood Mycobacterium tuberculosis interferon-γ release assay（TB-IGRA ）in early adjuvant diagnosis of tuberculous meningitis（TBM）.Methods 56 patients with TBM （trial group） and 56 patients with non-TB meningitis （control group） admitted to West China Hospital of Sichuan University in January-December 2015 were analyzed, results of TB-IGRA, cerebrospinal fluid（CSF） Mycobacterium tuberculosis（MT） culture, and CSF TB-DNA testing of two groups of patients were analyzed, the sensitivity and specificity of each diagnostic method were calculated.Results The sensitivity of TB-IGRA, CSF MT culture, and CSF TB-DNA for diagnosis of TBM were 87.5%（49/56）, 19.6%（11/56）, and 60.7%（34/56） respectively,specificity were 89.3%（50/56）, 100.0%（56/56）, and 76.8%（43/56）respectively.The sensitivity of TB-IGRA for diagnosing TBM was higher than that of CSF TB-DNA and CSF MT culture, specificity of TB-IGRA was higher than that of CSF TB-DNA（89.3%〉76.8%）, pairwise comparison showed a significant difference（all P〈0.01）.Among 11 cases confirmed by CSF culture, 10 （90.9%[10/11]）were positive for TB-IGRA;among 45 cases with clinical diagnosis and effective anti-tuberculosis treatment, 39 （86.7%[39/45]）were positive for TB-IGRA.Conclusion TB-IGRA is highly sensitive and specific in the early adjuvant diagnosis of TBM, it is convenient, rapid, effective, and worthy to be popularized in clinical practice.
出处
《中国感染控制杂志》
CAS
北大核心
2017年第9期837-840,共4页
Chinese Journal of Infection Control
关键词
结核分枝杆菌γ-干扰素释放试验
结核性脑膜炎
诊断
鉴别诊断
Mycobacterium tuberculosis
interferon-γ release assay
tuberculous meningitis
diagnosis
differential diagnosis
