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目的:探讨γ-干扰素释放实验(interferon gamma releasing assay,IGRAs)在支气管扩张合并非结核分枝杆菌(nontuberculosis mycobacteria,NTM)肺病和支气管扩张合并肺结核(tuberculosis,TB)鉴别诊断中的价值。方法:收集广州市胸科医院2014年1-12月根据细菌学诊断的支气管扩张分枝杆菌阳性患者436例,其中支气管扩张合并非结核分枝杆菌肺病患者150例,行IGRAs检测64例;支气管扩张合并肺结核患者284例,行IGRAs检测71例,对两种疾病的IGRAs检测结果进行回顾性分析。结果:IGRAs检测在支扩并NTM肺病和支扩并肺TB鉴别诊断中的敏感度(Se)95.77%(68/71,95%CI为93.3%~97.3%),特异度(Sp)92.19%(59/64,95%CI为87.4%~95.2%)。IGRAs检测的阳性预测值(PPV)和阳性似然比(+LR)分别为93.15%(68/73,95%CI为89.3%~95.7%)和12.259(95%CI为5.276~28.483);阴性预测值(NPV)和阴性似然比(-LR)分别为95.16%(59/62,95%CI为92.1%~97.1%)和0.0458(95%CI为0.0151~0.139)。NTM组和TB组IGRAs检测定性比较(χ2=101.357,P=0.000);定量比较ESAT-6(A孔)斑点数(t=-8.104,P=0.000);CFP-10(B孔)斑点数(t=-11.193,P=0.000),差异有统计学意义(P均<0.05)。结论:支气管扩张合并分枝杆菌肺病的患者,行IGRAs检测能早期、快速、无创、准确地判断为非结核分枝杆菌肺病或是肺结核,对临床诊断和治疗有指导意义。
Objective: To investigate the value of interferon gamma releasing assay (IGRAs) in differential diagnosis of bronchiectasis combined with nontuberculosis mycobacteria (NTM) and bronchiectasis combined with tuberculosis (TB). Methods: A total of 436 patients with mycobacterium tuberculosis diagnosed by bacteriology from January to December 2014 in Guangzhou Chest Hospital were enrolled. Among them, 150 cases of bronchiectasis with non-tuberculous mycobacterium tuberculosis were examined with IGRAs in 64 cases. Bronchus A total of 284 patients with pulmonary tuberculosis were enrolled in this study. Totally 71 IGRAs were detected. The results of IGRAs were analyzed retrospectively. Results: The sensitivity (Se) of IGRAs was 95.77% (68/71, 95% CI 93.3% -97.3%) and specificity (Sp 92.19%) in supporting bronchiectasis and NTM lung disease and bronchiectasis and pulmonary TB. (59/64, 95% CI 87.4% ~ 95.2%). The positive predictive value (PPV) and positive likelihood ratio (+ LR) of IGRAs were 93.15% (68/73, 95% CI 89.3% ~ 95.7%) and 12.259 (95% CI 5.276 ~ 28.483) The predicted value (NPV) and negative likelihood ratio (LRR) were 95.16% (59/62, 95% CI 92.1% -97.1%) and 0.0458 (95% CI 0.0151-0.1339) respectively. The number of spots in ESAT-6 (A hole) (t = -8.104, P = 0.000) and CFP-10 (B hole) spots in NTM group and TB group were qualitatively compared (χ2 = 101.357, (t = -11.193, P = 0.000), the difference was statistically significant (all P <0.05). Conclusions: Patients with bronchiectasis and mycobacterium tuberculosis can perform early, rapid, noninvasive and accurate diagnosis of non-tuberculosis mycobacterium tuberculosis or pulmonary tuberculosis in patients with mycobacterium tuberculosis, which is instructive for clinical diagnosis and treatment.