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TB-DNA、IGRAs、TB-Ab在肺结核中的诊断价值 被引量:1

The diagnostic value of TB⁃DNA,IGRAs and TB⁃Ab in pulmonary tuberculosis
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摘要 目的探究结核分枝杆菌核酸(TB-DNA)、γ-干扰素释放试验(IGRAs)和结核分歧杆菌抗体(TB-Ab)检测在肺结核中的诊断价值。方法收集2022年6月至2023年1月莆田学院附属医院收治的154例疑似肺结核患者,所有患者均接受TB-DNA、IGRAs和TB-Ab检测,评价不同检测方法的检测阳性率、诊断肺结核的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率;采用受试者工作特征曲线(ROC)评估不同检测方法对肺结核的诊断效能。结果154例疑似肺结核患者中,107例确诊为肺结核(肺结核组),47例确诊为非肺结核的其他肺部疾病(对照组)。肺结核组TB-DNA、IGRAs和TB-Ab阳性率均高于对照组,差异有统计学意义(P<0.05)。TB-DNA、IGRAs检测诊断肺结核的灵敏度和诊断准确率均高于TB-Ab检测,差异有统计学意义(P<0.05),TB-DNA检测诊断肺结核的阴性预测值高于TB-Ab检测,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,TB-DNA诊断肺结核的AUC为0.851(明显大于IGRAs诊断的0.770)、TB-Ab诊断的0.770,IGRAs诊断的AUC明显大于TB-Ab,差异均有统计学意义(P<0.05)。IGRAs+TB-DNA联合诊断的灵敏度、诊断准确率明显高于IGRAs单独检测(P<0.05);IGRAs+TB-Ab联合诊断的灵敏度明显高于IGRAs、TB-Ab单独检测,诊断准确率明显高于TB-Ab单独检测(P<0.05);TB-DNA+TB-Ab联合诊断的灵敏度、阴性预测值、诊断准确率明显高于TB-Ab单独检测(P<0.05)。TB-DNA、IGRAs、TB-Ab两两联合检测和三者联合检测诊断肺结核的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率比较,差异均无统计学意义(P>0.05)。结论相比TB-Ab和IGRAs检测,TB-DNA检测对肺结核的诊断价值更高;TB-DNA、IGRAs、TB-Ab两两联合检测对肺结核的诊断效能高于单一指标检测。 Objective To explore the diagnostic value of tuberculosis deoxyribonucleic acid(TB⁃DNA),interferon⁃gamma release assays(IGRAs),tuberculosis antibody(TB⁃Ab),and their combination in pulmonary tuberculosis.Methods The clinical data of 154 patients suspected of having pulmonary tuberculo⁃sis and admitted to the Affiliated Hospital of Putian University from June 2022 to January 2023 were collected retrospectively.All patients underwent TB⁃DNA,IGRAs,and TB⁃Ab tests.The positivity rates of the differ⁃ent detection methods,as well as their sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy in diagnosing pulmonary tuberculosis,were evaluated.Receiver Operating Characteristic(ROC)curves were used to assess the diagnostic efficacy of the different detection methods for pulmonary tuberculosis.Results Among 154 patients suspected of pulmonary tuberculosis,107 were diag⁃nosed with pulmonary tuberculosis(the tuberculosis group),and 47 were diagnosed with other pulmonary dis⁃eases excluding pulmonary tuberculosis(the control group).The positive rates of TB⁃DNA,IGRAs,and TB⁃Ab in the tuberculosis group were higher than those in the control group(P<0.05).In diagnosing pulmo⁃nary tuberculosis,the sensitivity and accuracy of TB⁃DNA and IGRAs were higher than those of TB⁃Ab(P<0.05).and the negative predictive value of TB⁃DNA was higher than that of TB⁃Ab(P<0.05).Results from ROC curve analysis showed that the AUC of TB⁃DNA for diagnosing pulmonary tuberculosis was 0.851,sig⁃nificantly greater than that of IGRAs(0.770)or TB⁃Ab(0.770).The AUC of IGRAs was significantly greater than that of TB⁃Ab(P<0.05).The diagnostic sensitivity and accuracy of IGRAs combined with TB⁃DNA were significantly higher than those of IGRAs alone(P<0.05).The diagnostic sensitivity of IGRAs combined with TB⁃Ab was significantly higher than that of IGRAs or TB⁃Ab alone,and the diagnostic accuracy was sig⁃nificantly higher than that of TB⁃Ab(P<0.05).The sensitivity,negative predictive value,and accuracy of TB⁃DNA combined with TB⁃Ab were significantly higher than those of TB⁃Ab alone(P<0.05).There was no statistically significant difference in sensitivity,specificity,positive predictive value,negative predictive val⁃ue,or diagnostic accuracy among pairwise combination of TB⁃DNA,IGRAs and TB⁃Ab,and the combina⁃tion of all three for diagnosing pulmonary tuberculosis(P>0.05).Conclusion Compared to TB⁃Ab tests and IGRAs,TB⁃DNA tests have a higher diagnostic value for tuberculosis.The diagnostic efficiency of the pair⁃wise combination of T B⁃DNA,IGRAs and TB⁃Ab in cases of pulmonary tuberculosis was higher than that of single indicator detection.
作者 林华 刘相玉 陈展飞 俞柳敏 LIN Hua;LIU Xiangyu;CHEN Zhanfei;YU Liumin(Department of Laboratory,Putian University Affiliated Hospital,Putian,Fujian,China,351100)
出处 《分子诊断与治疗杂志》 2024年第5期917-920,925,共5页 Journal of Molecular Diagnostics and Therapy
基金 福建首莆田市市科技计划项目(2023S3F0010)。
关键词 肺结核 结核分枝杆菌核酸 Γ-干扰素释放试验 结核分歧杆菌抗体 Pulmonary tuberculosis Tuberculosis deoxyribonucleic acid Interferon⁃gamma re⁃lease assays Tuberculosis antibody
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