本文選題：全血γ干擾素釋放試驗(yàn) + 活動(dòng)性結(jié)核�。� 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：目的：全血γ干擾素釋放試驗(yàn)QuantiFERON-TB Gold in-Tube(QFT-GIT)是近年來(lái)發(fā)展起來(lái)的γ干擾素釋放試驗(yàn)之一,由于其操作方便,對(duì)設(shè)備要求低,在國(guó)際上被廣泛用于輔助活動(dòng)性結(jié)核的診斷,但該試劑盒在國(guó)內(nèi)尚未上市使用,同時(shí)年齡、免疫抑制劑或抗結(jié)核治療等因素對(duì)檢測(cè)結(jié)果是否有影響仍然存在疑問(wèn)。本研究比較了在我國(guó)這一結(jié)核病高發(fā)地區(qū),QFT-GIT用于兒童和成人活動(dòng)性結(jié)核的診斷價(jià)值,并探討了激素以及抗結(jié)核治療對(duì)其結(jié)果的影響。方法：研究入組臨床懷疑活動(dòng)性結(jié)核的兒童60名,成人212名,采血進(jìn)行QFT-GIT檢測(cè)；同時(shí)收集每位患者的臨床癥狀、病原學(xué)、病理學(xué)、影像學(xué)、治療方案等相關(guān)信息,進(jìn)行診斷分類(lèi)。比較分析QFT-GIT在兒童和成人中的診斷價(jià)值,并探討檢測(cè)前接受激素和抗結(jié)核治療對(duì)結(jié)果的影響。結(jié)果：QFT-GIT在兒童中用于診斷活動(dòng)性結(jié)核的靈敏度為83.%(95%CI66.3%-94.6%),特異度為88.5%(95%CI 70.2%-96.8%),陽(yáng)性預(yù)測(cè)值為92.9%(95%CI76.5%-99.1%),陰性預(yù)測(cè)值為82.1%(95%CI 63.1%-93.9%)。在成人中用于診斷活動(dòng)性結(jié)核的靈敏度為73.7%(95%CI 57.8%-85.2%),特異度為70.4%(95%CI62.9%-77.0%),陽(yáng)性預(yù)測(cè)值為47.5%(95%CI 35.3%-60.0%),陰性預(yù)測(cè)值為93.3%(95%CI 87.2%-96.8%)。激素治療對(duì)絲裂原引起的γ干擾素釋放會(huì)產(chǎn)生抑制作用(P0.05)。在QFT_GIT檢測(cè)前接受激素治療的結(jié)核患者中,25.0%的兒童出現(xiàn)假陰性結(jié)果,28.6%的成人出現(xiàn)不確定結(jié)果,而接受抗結(jié)核治療的成人結(jié)核患者,有44.4%出現(xiàn)假陰性結(jié)果。同時(shí)研究還發(fā)現(xiàn),無(wú)論在兒童還是成人中,活動(dòng)性結(jié)核患者的絲裂原引起的γ干擾素釋放水平均較非活動(dòng)性結(jié)核患者低。結(jié)論：QFT-GIT在兒童中用于診斷活動(dòng)性結(jié)核的靈敏度和特異度均高于成人。激素治療對(duì)兒童和成人的檢測(cè)結(jié)果存在負(fù)面影響,抗結(jié)核治療會(huì)降低檢測(cè)方法的靈敏度。因此,我們推薦在抗結(jié)核治療開(kāi)始前進(jìn)行QFT-GIT檢測(cè),并且避免使用于接受過(guò)免疫抑制劑如激素治療的患者。QFT-GIT檢測(cè)結(jié)果的定量分析,對(duì)于監(jiān)測(cè)疾病進(jìn)展過(guò)程中機(jī)體結(jié)核特異性和非特異性免疫水平有重要參考價(jià)值。
[Abstract]:Objective: the whole blood interferon 緯 release test (QuantiFERON-TB Gold in-Tubeus QFT-GITT) is one of the developed interferon 緯 release tests in recent years. Because of its convenient operation and low requirements for equipment, it has been widely used in the international diagnosis of active tuberculosis. However, the kit is not yet available in China, and there are still questions about whether age, immunosuppressant or antituberculous therapy have any effect on the test results. This study compared the diagnostic value of QFT-GIT for active tuberculosis in children and adults in this high incidence area of tuberculosis in China, and discussed the effect of hormone and antituberculous therapy on the results. Methods: blood samples were collected from 60 children and 212 adults with suspected active tuberculosis, and their clinical symptoms, etiology, pathology, imaging and treatment plan were collected. Carry out diagnostic classification. To compare and analyze the diagnostic value of QFT-GIT in children and adults, and to explore the effect of hormone and antituberculous therapy before testing. Results the sensitivity for the diagnosis of active tuberculosis in children was 83.95 and the sensitivity was 83.95 and the accuracy was 88.5%(95%CI 70.2-96.8.The positive predictive value was 92.99-95CI76.5-99.1and the negative predictive value was 82.1%(95%CI 63.1- 93.90.The negative predictive value was 63.1- 93.90.The sensitivity was 70.2-96.80.The positive predictive value was 92.99-95CI76.5-99.1C, and the negative predictive value was 82.1%(95%CI 63.1-93.9B. The sensitivity for diagnosis of active tuberculosis in adults was 73.7%(95%CI 57.8-85.2, the specificity was 70.4 and the CI62.9-77.0, the positive predictive value was 47.5%(95%CI 35.3-60.0 and the negative predictive value was 93.3%(95%CI 87.2 -96.80.The positive predictive value was 47.5%(95%CI 35.3-60.0 and the negative predictive value was 93.3%(95%CI 87.2 -96.80.The positive predictive value was 47.5%(95%CI 35.3- 60.0 and the negative predictive value was 93.3%(95%CI 87.2-96.8. Hormone therapy can inhibit the release of interferon 緯 induced by mitogen. Among the tuberculosis patients who received hormone therapy before QFT_GIT test, 25.0% of children had false negative results and 28.6% of adults had uncertain results, while 44.4% of adult TB patients who received anti-tuberculosis treatment had false negative results. It was also found that the release level of IFN- 緯 in active TB patients was lower than that in non-active TB patients, both in children and adults. Conclusion the sensitivity and specificity of the diagnosis of active tuberculosis in children were higher than those in adults. Hormone therapy has a negative effect on the test results in children and adults, and anti-tuberculosis therapy reduces the sensitivity of the test method. Therefore, we recommend that QFT-GIT tests be performed before the start of anti-TB therapy and avoid quantitative analysis of QFT-GIT results in patients who have been treated with immunosuppressants such as hormones. It has important reference value for monitoring the specific and non-specific immune level of tuberculosis in the process of disease progression.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R52

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