發(fā)布時(shí)間：2018-05-21 06:11

  本文選題：γ-干擾素釋放試驗(yàn)(IGRA) + 發(fā)熱��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：背景：臨床上很多發(fā)熱患者病因診斷比較困難，感染性疾病是發(fā)熱的主要原因，我國(guó)發(fā)熱的患者中結(jié)核菌感染患者可能較多。非結(jié)核病若誤診為結(jié)核病，應(yīng)用抗結(jié)核藥物后可引起肝、腎損害；結(jié)核病一旦漏診則會(huì)延誤病情，若因?yàn)槠渌蛐枰獞?yīng)用激素類藥物而未進(jìn)行抗結(jié)核治療則可能引起結(jié)核菌感染播散。為避免過(guò)度治療或延誤病情，早期正確診斷和及時(shí)控制結(jié)核菌感染都有極其重要意義。對(duì)于那些臨床上沒(méi)有明確結(jié)核感染灶的發(fā)熱患者，目前的技術(shù)對(duì)于結(jié)核菌感染的診斷比較困難。T-SPOT.TB于2008年成為FDA認(rèn)證的第四個(gè)γ-干擾素釋放試驗(yàn)（IGRA），許多國(guó)內(nèi)外研究均提示T-SPOT.TB檢測(cè)在診斷結(jié)核病與潛伏性結(jié)核方面有較高的敏感度和特異度，但在發(fā)熱患者中結(jié)核菌感染診斷的敏感度和特異度罕有報(bào)道。 目的：對(duì)于無(wú)明確結(jié)核感染灶的發(fā)熱患者結(jié)核菌感染的診斷比較困難，IGRA作為結(jié)核菌感染體外免疫檢測(cè)的新方法，近幾年在臨床上得到廣泛應(yīng)用。本研究對(duì)發(fā)熱患者進(jìn)行T-SPOT.TB檢測(cè)，并對(duì)該檢測(cè)在發(fā)熱患者中的應(yīng)用價(jià)值進(jìn)行探討。 方法：以456例發(fā)熱患者作為研究對(duì)象，所有患者在進(jìn)行相關(guān)檢查后沒(méi)有明確發(fā)熱原因，或不除外結(jié)核菌感染，進(jìn)行T-SPOT.TB檢測(cè)。采用SPSS17.0統(tǒng)計(jì)軟件，對(duì)患者的臨床診斷和T-SPOT.TB檢測(cè)結(jié)果進(jìn)行分析。 結(jié)果： 1.456例患者中T-SPOT.TB檢測(cè)陽(yáng)性為203例(203/456，44.5%)，T.SPOT-TB檢測(cè)可疑陽(yáng)性為21例(21/456，4.6%)，T-SPOT.TB檢測(cè)陰性為232例(232/456，50.9%)。 2. T-SPOT.TB檢測(cè)陽(yáng)性與陰性組之間在年齡、既往有無(wú)結(jié)核病史方面均無(wú)顯著性差異，但在患者性別方面有統(tǒng)計(jì)學(xué)意義，T-SPOT.TB檢測(cè)陽(yáng)性組中男性患者多于女性。 3.本研究中有85例患者臨床診斷為結(jié)核病例（其中肺內(nèi)結(jié)核34例，結(jié)核菌感染24例，結(jié)核性胸膜炎10例，其他部位結(jié)核17例），371例患者無(wú)明確結(jié)核菌感染證據(jù)（其中42例疑似結(jié)核病例，329例非結(jié)核病例）。 4. T-SPOT.TB檢測(cè)在發(fā)熱患者中診斷結(jié)核菌感染的敏感度較高，為84.3%，陰性預(yù)測(cè)值達(dá)94.2%，特異度為68.1%，陽(yáng)性預(yù)測(cè)值為41.4%，Kappa值為0.380，ROC曲線下面積為0.762（95%CI：70.7%-81.7%）。在FUO中診斷結(jié)核的敏感度為85.5%，陰性預(yù)測(cè)值達(dá)90.9%，特異度為60.6%，，陽(yáng)性預(yù)測(cè)值為47.5%，Kappa值為0.373，ROC曲線下面積為0.730（95%CI：65.4%-80.6%）。 5．T-SPOT.TB檢測(cè)在肺內(nèi)、肺外結(jié)核的敏感度分別為78.1%、88.2%，陰性預(yù)測(cè)值分別為92.6%、95.3%，Kappa值分別為0.299、0.438，ROC曲線下面積分別為0.719（95%CI：62.3%-81.5%）、0.791（95%CI：72.4%-85.7%）。 6.在329例非結(jié)核病例中有99例T-SPOT.TB檢測(cè)陽(yáng)性。 結(jié)論： 1. T-SPOT.TB檢測(cè)結(jié)果不受既往結(jié)核病史影響。 2. T-SPOT.TB因其有較高的陰性預(yù)測(cè)值，對(duì)排除結(jié)核菌感染有重要意義。 3. T-SPOT.TB檢測(cè)可作為結(jié)核病、結(jié)核菌感染診斷的輔助工具，尤其是肺外結(jié)核。 4.應(yīng)用T-SPOT.TB可以在發(fā)熱患者中發(fā)現(xiàn)那些無(wú)明確結(jié)核感染灶的結(jié)核菌感染者，尤其是那些需要定期隨訪的潛伏性結(jié)核感染者。
[Abstract]:Background: the etiology of many patients with fever is difficult to diagnose. Infectious disease is the main cause of fever. There may be more tuberculosis infection in the patients with fever in our country. If non tuberculosis is misdiagnosed as tuberculosis, the application of anti tuberculosis drugs can cause liver and kidney damage; once the disease is missed, the disease will delay the disease, if because of the others The reason for the need to use hormone drugs without anti tuberculosis treatment may cause tuberculosis infection to spread. It is of great significance to avoid excessive treatment or delay the disease, early correct diagnosis and timely control of tuberculosis infection. For those with no definite tuberculosis infection, the current technology is for tuberculosis. The diagnosis of bacterial infection is relatively difficult.T-SPOT.TB became the fourth FDA certified interferon release test (IGRA) in 2008. Many domestic and foreign studies have suggested that T-SPOT.TB detection has high sensitivity and specificity in the diagnosis of tuberculosis and latent tuberculosis, but the sensitivity and specificity of the diagnosis of tuberculosis infection in fever patients are rare. There is a report.
Objective: the diagnosis of tuberculosis infection in fever patients with no definite tuberculosis infection is difficult. IGRA is a new method for the detection of Mycobacterium tuberculosis in vitro, and it has been widely used clinically in recent years. This study was used to detect T-SPOT.TB in patients with fever and to explore the application value of this test in fever patients.
Methods: 456 cases of fever patients were taken as the research object. All the patients did not have a definite cause of fever after the related examination, or did not exclude Mycobacterium tuberculosis, and carried out T-SPOT.TB detection. The SPSS17.0 statistical software was used to analyze the clinical diagnosis of the patients and the results of T-SPOT.TB detection.
Result錛

本文編號(hào)：1918066