摘要目的 探讨干扰素γ释放试验(IGRA)联合结核菌素皮肤试验(TST)在眼内结核和潜伏性结核感染诊断中的应用价值.方法 选取2016年1月至2018年12月河北省胸科医院收治的110例肺结核患者(观察组)和80例健康体检者(对照组).110例结核患者中,眼内结核35例,潜伏性结核感染75例.均行眼分泌物IGRA和TST检查.结果 观察组IGRA和TST阳性率明显高于对照组[88.18%(97/110)比11.25%(9/80)和83.64%(92/110)比41.25%(33/80)],差异有统计学意义(χ2=113.138和36.971,P﹤0.01).眼内结核患者IGRA阳性率明显高于潜伏性眼内结核感染患者[97.14%(34/35)比84.00%(63/75)],差异有统计学意义(χ2=3.955,P﹤0.05);眼内结核患者TST阳性率与潜伏性眼内结核感染患者比较差异无统计学意义[91.43%(32/35)比80.00%(60/75),χ2=2.277,P＞0.05].IGRA与TST检查结果的一致率为89.90%(Kappa=0.867, P＞0.05). IGRA联合TST检查的灵敏度明显高于IGRA和TST单项检查(97.83%比88.18%和83.64%),而特异度明显低于IGRA和TST单项检测(61.11%比92.31%和83.33%),差异有统计学意义(P﹤0.05).受试者工作特征曲线分析结果显示,IGRA诊断眼内结核和潜伏性眼内结核感染的曲线下面积为 0.781,TST 曲线下面积为 0.604,IGRA 联合 TST 曲线下面积为 0.679.结论IGRA在眼内结核和潜伏性结核感染诊断中具有较高的价值,可作为眼内结核的诊断手段.

abstractsObjective To explore the application value of interferon gamma release assay (IGRA) combined with tuberculin skin test (TST) in diagnosis of intraocular tuberculosis and latent tuberculosis infection. Methods One hundred and ten patients with pulmonary tuberculosis (observation group) and 80 healthy persons (control group) in Hebei Chest Hospital from January 2016 to December 2018 were selected. Among the 110 patients with pulmonary tuberculosis, intraocular tuberculosis was in 35 cases, and latent tuberculosis infection was in 75 cases. All the patients were examined by ocular secretions IGRA and TST. Results The positive rates of IGRA and TST in observation group were significantly higher than those in control group: 88.18% (97/110) vs. 11.25% (9/80) and 83.64% (92/110) vs. 41.25% (33/80), and there were statistical differences (χ2=113.138 and 36.971, P﹤0.01). The positive rate of IGRA in patients with intraocular tuberculosis was significantly higher than that in latent tuberculosis infection: 97.14% (34/35) vs. 84.00% (63/75), and there was statistical difference (χ2=3.955, P﹤0.05). There was no statistical difference in the positive rate of TST between the patients with intraocular tuberculosis and patients with latent tuberculosis infection: 91.43% (32/35) vs. 80.00% (60/75), χ2 = 2.277, P＞0.05. The consistency rate of IGRA and TST was 89.90% (Kappa=0.867, P＞0.05). The sensitivity of IGRA combined with TST was significantly higher than the single detection of IGRA and TST (97.83% vs. 88.18% and 83.64% ), while the specificity of IGRA combined with TST was significantly lower than the single detection of IGRA and TST (61.11% vs. 92.31% and 83.33% ), and there were statistical differences (P﹤0.05). The receiver operating characteristic curve analysis result showed that the area under curve of IGRA in diagnosis of intraocular tuberculosis and latent tuberculosis infection was 0.781, area under curve of TST was 0.604, and area under curve of IGRA combined with TST was 0.679. Conclusions IGRA has high value in the diagnosis of intraocular tuberculosis and latent tuberculosis infection, and can be used as a diagnostic means of intraocular tuberculosis.