摘要目的 探讨胸水中体外诱发的γ-干扰素释放测定(IGRA)在结核性胸膜炎诊断中的价值.方法 收集本院2009年11月至2012年1月呼吸内科连续收治的62例病理确诊的结核性胸膜炎患者和30例其他原因如肿瘤、炎性反应的胸膜炎患者,治疗前两周内收集胸水,结核分枝杆菌早期分泌抗原靶6(ESAT-6)刺激后应用ELISA法进行γ-干扰素浓度测定.结果 结核性胸膜炎患者胸水经ESAT-6抗原刺激后,γ-干扰素增加的百分率为16％～ 53％,IGRA的阳性率为90.3％(56/62)；非结核性胸水患者经ESAT-6抗原刺激后,γ-干扰素增加6％～8％,30例中有2例IGRA为临界状态,其余均为阴性.结核性胸膜炎患者胸水γ-干扰素基础值水平也高于非结核性胸水患者[(1825±69) ng/L比(967±105) ng/L,P＜0.05].结论 胸水IGRA检测有望成为鉴别结核性胸膜炎的一种准确可靠的方法.

abstractsObjective To explore the value of interferon-γ (IFN-γ) release assay (IGRA) of pleural effusion in the diagnosis of tuberculous pleuritis.Methods Between November 2009 and January 2012,62 patients with pathologically confirmed diagnosis of tuberculous pleuritis and 30 with miscellaneous diseases (i.e.tumor and inflammatory pleuritis) from the Department of Respiratory Internal Medicine,Henan Provincial Chest Hospital were enrolled in the study.The pleural effusion was sampled 2 weeks prior to the treatment.IFN-γ concentration was measured by enzyme-linked immunosorbent assay following stimulation with early secretory antigen target-6 (EAST-6) for Mycobacterium tuberculosis.Results Positire rate of IGRA was 90.3％ (56/62) in tuberculous pleuritis patients,with an increase by 16％-53％ in IFN-γ production.Though patients with non-tuberculous pleuritis yielded a 6％-8％ increment in IFN-γ release following EAST-6 stimulation,30 cases tested negatively to IGRA with exception of 2 with borderline positive results.Pleuralfluid of tuberculous pleuritis patients was characterized by a higher level of IFN-γ than that of other patients [(1825 ± 69)ng/L vs (967 ± 105)ng/L,P＜0.05].Conclusion Pleural fluid IGRA is a potentially accurate and reliable approach for differential diagnosis of tuberculous pleuritis.