[胸腔积液干扰素-γ（IFN-γ）检测作为结核性胸膜炎的诊断工具]

[Pleural fluid interferon-gamma (IFN-gamma) measurement as a diagnostic tool in tuberculous pleurisy].

作者信息

Krenke Rafał, Safianowska Aleksandra, Paplińska Magdalena, Korczyński Piotr, Dmowska-Sobstyl Barbara, Bogacka-Zatorska Elzbieta, Jaworski Andrzej, Chazan Ryszarda

机构信息

Katedra i Klinika Chorób Wewnetrzynch, Pneumonologii i Alergologii UM w Warszawie, ul. Banacha 1A, Warsaw.

出版信息

Pneumonol Alergol Pol. 2008;76(4):237-45.

PMID:18785128

Abstract

INTRODUCTION

Tuberculosis is one of the most common causes of pleural effusion (PE). However, the diagnosis of tuberculous pleurisy still remains difficult. Since M. tuberculosis isolation rates in tuberculous effusions are relatively low the histological and microbiological studies of pleural biopsy samples are usually required to confirm the diagnosis. Several biological markers have been proposed to enhance the effectiveness of diagnosing patients with tuberculous pleurisy. The study was undertaken to evaluate the diagnostic accuracy of pleural fluid IFN-gamma concentration in differentiation between tuberculous pleural effusion (TPE) and non-tuberculous pleural effusion (nTPE).

MATERIAL AND METHODS

94 patients (50 M and 44 F, mean age 59 +/- 18, range 18-95 years) with PE were studied. All subjects underwent diagnostic thoracentesis and extensive laboratory pleural fluid evaluation. Tuberculous pleural effusion was diagnosed in: 1) patients with positive pleural fluid or pleural biopsy culture and 2) patients with granulomas in the pleural biopsy specimen, after exclusion of other granulomatous diseases. IFN-gamma level in pleural fluid was measured with commercially available immunoenzymatic assay (Quantikine Human IFN-gamma Immunoassay, R&D Systems, USA).

RESULTS

Tuberculous pleural effusion was diagnosed in 28 pts. The non-tuberculous pleural effusion group consisted of 66 pts, including 35 with malignant PE, 20 with parapneumonic effusion or pleural empyema, 5 with pleural transudates due to heart failure, and 6 with miscellaneous causes of PE. The mean concentration of IFN-g was significantly higher in TPE than in nTPE (614.1 +/- 324.5 vs. 15.1 +/- 36.0 pg/ml, p < 0.0001). At the cut-off value of 100 pg/ml the sensitivity and specificity of the test were 100% and 98,5% respectively.

CONCLUSION

The pleural fluid concentration of IFN-gamma was found to be highly sensitive and specific marker of tuberculous pleurisy.

摘要

引言

肺结核是胸腔积液（PE）最常见的病因之一。然而，结核性胸膜炎的诊断仍然困难。由于结核性胸腔积液中结核分枝杆菌的分离率相对较低，通常需要对胸膜活检样本进行组织学和微生物学研究以确诊。已经提出了几种生物标志物来提高结核性胸膜炎患者诊断的有效性。本研究旨在评估胸腔积液干扰素-γ浓度在鉴别结核性胸腔积液（TPE）和非结核性胸腔积液（nTPE）中的诊断准确性。

材料与方法

对94例胸腔积液患者（50例男性和44例女性，平均年龄59±18岁，范围18 - 95岁）进行研究。所有受试者均接受诊断性胸腔穿刺术和广泛的胸腔积液实验室评估。结核性胸腔积液的诊断标准为：1）胸腔积液或胸膜活检培养阳性的患者；2）在排除其他肉芽肿性疾病后，胸膜活检标本中有肉芽肿的患者。采用市售免疫酶测定法（Quantikine Human IFN-γ Immunoassay，美国R&D Systems公司）测定胸腔积液中的干扰素-γ水平。

结果

28例患者被诊断为结核性胸腔积液。非结核性胸腔积液组由66例患者组成，包括35例恶性胸腔积液、20例肺炎旁胸腔积液或胸膜脓胸、5例因心力衰竭导致的胸腔漏出液以及6例其他原因导致的胸腔积液。TPE组中干扰素-γ的平均浓度显著高于nTPE组（614.1±324.⑤ vs. 15.1±36.0 pg/ml，p < 0.0001）。在临界值为100 pg/ml时，该检测的敏感性和特异性分别为100%和98.5%。