γ-干扰素释放试验在非结核分枝杆菌疾病中的表现：一项中国的回顾性研究。
The performance of interferon-gamma release assay in nontuberculous mycobacterial diseases: a retrospective study in China.
作者信息
Wang Mao-Shui, Wang Jun-Li, Wang Xin-Feng
机构信息
Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013, People's Republic of China.
Center of Clinical Laboratory, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, China.
出版信息
BMC Pulm Med. 2016 Nov 25;16(1):163. doi: 10.1186/s12890-016-0320-3.
BACKGROUND
The interferon-gamma release assay (IGRA) is more specific than the tuberculin skin test to discriminate between tuberculosis (TB) and nontuberculous mycobacterial (NTM) diseases. Here we performed a retrospective study to evaluate the performance of the T-SPOT.TB in patients with NTM diseases.
METHODS
Between March, 2013 and Nov, 2015, a total of 58 patients with NTM diseases had a T-SPOT.TB performed were enrolled, 30 patients had definite NTM diseases, 28 had probable diseases. Their clinicopathological characteristics were reviewed and analyzed. Cultures for mycobacteria were performed. The indirect proportion method with Löwenstein-Jensen (L-J) medium was used for first-line drug susceptibility test. T-SPOT.TB assay was performed according to the manufacturer's instructions. Data were expressed as mean ± standard deviation (continuous variables) and as numbers and percentages (categorical variables). The χ test was used for comparisons between proportions.
RESULTS
The average age was 51.8 ± 16.1 years (range 10 to 77 years), 58.6% (34/58) were male. 16.4% (9/55) were TB-PCR positive. 34 (58.6%) isolates were Mycobacterium intracellulare, ten (17.2%) were Mycobacterium chelonae and seven (12.1%) were Mycobacterium fortuitum. Fifty-two (89.7%) patients were NTM lung disease, five (8.6%) were pleural disease, and one (1.7%) lymphadenitis. The total positivity of T-SPOT.TB was 53.4% (31/58) among the whole group (probable and definite). For probable cases, the T-SPOT.TB assay was positive in 53.5% (15/28); for definite cases, 16 (53.3%) of 30 definite cases were positive. There was no statistical difference in the positivity rate between them (P < 0.01).
CONCLUSIONS
In the study, we showed that a significant portion of NTM diseases were T-SPOT.TB positive in China. Although T-SPOT.TB is useful diagnostic method for differentiating TB from NTM diseases, in China, the IGRA assay show limited value in the discrimination. In addition, further research is needed to investigate the association between TB infection and treatment for NTM patients.
背景
干扰素-γ释放试验（IGRA）在区分结核病（TB）和非结核分枝杆菌（NTM）疾病方面比结核菌素皮肤试验更具特异性。在此，我们进行了一项回顾性研究，以评估T-SPOT.TB在NTM疾病患者中的表现。
方法
2013年3月至2015年11月期间，共纳入58例接受T-SPOT.TB检测的NTM疾病患者，其中30例为确诊的NTM疾病患者，28例为疑似患者。回顾并分析了他们的临床病理特征。进行了分枝杆菌培养。采用罗氏（L-J）培养基间接比例法进行一线药敏试验。T-SPOT.TB检测按照制造商的说明进行。数据以平均值±标准差（连续变量）以及数量和百分比（分类变量）表示。采用χ检验比较比例。
结果
平均年龄为51.8±16.1岁（范围10至77岁），58.6%（34/58）为男性。16.4%（9/55）的患者TB-PCR呈阳性。34株（58.6%）分离菌为胞内分枝杆菌，10株（17.2%）为龟分枝杆菌，7株（12.1%）为偶然分枝杆菌。52例（89.7%）患者为NTM肺病，5例（8.6%）为胸膜疾病，1例（1.7%）为淋巴结炎。在整个组（疑似和确诊）中，T-SPOT.TB的总阳性率为53.4%（31/58）。对于疑似病例，T-SPOT.TB检测的阳性率为53.5%（15/28）；对于确诊病例，30例确诊病例中有16例（53.3%）呈阳性。两者之间的阳性率无统计学差异（P<0.01）。
结论
在本研究中，我们发现中国相当一部分NTM疾病患者的T-SPOT.TB呈阳性。虽然T-SPOT.TB是区分TB和NTM疾病的有用诊断方法，但在中国，IGRA检测在鉴别方面的价值有限。此外，需要进一步研究以调查TB感染与NTM患者治疗之间的关联。
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