全血 γ-干扰素释放试验对结核性脑膜炎的早期辅助诊断价值探讨

Value of blood interferon-γ release assay in early adjuvant diagnosis of tuberculous meningitis

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）。TBIGRA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。

Abstract:

ObjectiveTo evaluate the value of peripheral blood Mycobacterium tuberculosis interferonγ release assay（TBIGRA ）in early adjuvant diagnosis of  tuberculous meningitis(TBM).  Methods56 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. ResultsThe 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. ConclusionTB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.