营养不良对γ-干扰素释放试验检测结核病阳性率的影响

doi:10.19982/j.issn.1000-6621.20210709

摘要/Abstract

摘要：

目的: 探讨营养不良是否影响γ-干扰素释放试验(IGRA)检测结核病的阳性率。 方法: 查阅电子病历纳入2015年1月至2018年11月于四川大学华西医院呼吸与危重症医学科符合入组标准的443例住院结核病患者,根据体质量指数(BMI)分为营养不良组(BMI<18.5;136例)和非营养不良组(BMI≥18.5;307例)。采用酶联免疫吸附法在体外测定患者新鲜肝素化全血在结核特异性抗原刺激后释放γ-干扰素的浓度,比较IGRA对两组患者的检测阳性率。 结果: 443例患者中,IGRA检测营养不良组的阳性率[76.47%(104/136)]与非营养不良组[78.18%(240/307)]的差异无统计学意义(χ²=0.158,P=0.712)。在103例病原学确诊的结核病患者中,IGRA检测营养不良组的阳性率[75.61%(31/41)]与非营养不良组[80.65%(50/62)]的差异无统计学意义(χ²=0.373,P=0.542)。 结论: 营养不良不会影响结核病患者IGRA检测的阳性率。

关键词: 结核, 干扰素γ, 免疫学试验, 营养评价, 对比研究

Abstract:

Objective: To investigate whether malnutrition affects the positive rate of γ-interferon release assay (IGRA) in patients with tuberculosis. Methods: From January 2015 to November 2018, 443 patients with tuberculosis who were admitted to the Department of Respiratory and Critical Care Medicine, West China Hospital were included by reviewing electronic medical record. According to body mass index (BMI), they were divided into malnutrition group (BMI <18.5; 136) and no-malnutrition group (BMI ≥18.5; 307). Enzyme linked immunosorbent assay was used to measure the concentration of interferon-γ in fresh heparinized whole blood stimulated by tuberculosis specific antigen in vitro. The positive rate of IGRA in the two groups was compared. Results: A total of 443 patients, the positive rate of IGRA was 76.47% (104/136) in the malnourished group and 78.18% (240/307) in the no-malnutrition group, there was no significant difference between the two groups (χ²=0.158,P=0.712). Among the bacterium-confirmed tuberculosis patients, the positive rate of IGRA was 75.61% (31/41) in the malnutrition group and 80.65% (50/62) in the no-malnutrition group, there was no significant difference between the two groups (χ²=0.373,P=0.542). Conclusion: Malnutrition does not affect the positive rate of IGRA in patients with tuberculosis.

Key words: Tuberculosis, Interferon-gamma, Immunologic tests, Nutritional assessment, Comparative study

中图分类号:

拉巴, 张蒙蒙, 王明桂, 贺建清. 营养不良对γ-干扰素释放试验检测结核病阳性率的影响[J]. 中国防痨杂志, 2022, 44(6): 595-599. doi: 10.19982/j.issn.1000-6621.20210709

LA Ba, ZHANG Meng-meng, WANG Ming-gui, HE Jian-qing. Influence of malnutrition on positive rate of interferon gamma release assay (IGRA) in patients with tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(6): 595-599. doi: 10.19982/j.issn.1000-6621.20210709

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一般特征	营养不良组(136例)	非营养不良组(307例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	29.0(20.0,49.0)	39.0(27.0,52.0)	Z=-3.398	0.001
性别[例(构成比,%)]			χ²=7.239	0.007
男性	90(66.18)	161(52.44)
女性	46(33.82)	146(47.56)
身高[cm,M(Q₁,Q₃)]	165.0(160.0,170.8)	163.0(158.0,170.0)	Z=2.782	0.006
体质量[kg,M(Q₁,Q₃)]	47.0(42.0,50.0)	58.0(51.0,64.0)	Z=-16.903	<0.001
吸烟[例(发生率,%)]	53(38.97)	91(29.64)	χ²=3.739	0.053
饮酒[例(发生率,%)]	36(26.47)	68(22.15)	χ²=0.979	0.322
病原学检测任一阳性[例(阳性率,%)]	41(30.15)	62(20.20)	χ²=5.231	0.022

检测结果	营养不良组 (136例)	非营养不良组 (307例)	χ²值	P值
所有患者			0.158	0.712
阳性	104(76.47)	240(78.18)
阴性	32(23.53)	67(21.82)
病原学阳性患者			0.373	0.542
阳性	31(75.61)	50(80.65)
阴性	10(24.39)	12(19.35)

T淋巴细胞亚群	营养不良组(136例)	非营养不良组(307例)	Z值	P值
淋巴细胞计数[×10⁹/L,M(Q₁,Q₃)]	1.1(0.7,1.4)	1.2(0.8,1.6)	-1.866	0.062
CD3亚群[%,M(Q₁,Q₃)]^a	73.3(65.7,80.2)	73.0(66.1,79.5)	-0.223	0.824
CD4亚群[%,M(Q₁,Q₃)]^a	38.8(33.0,45.8)	38.3(29.6,45.7)	-0.474	0.635
CD8亚群[%,M(Q₁,Q₃)]^a	27.2(20.8,31.9)	26.2(20.0,33.0)	-0.609	0.542

淋巴细胞	IGRA阳性(89例)	IGRA阴性(29例)	统计检验值	P值
淋巴细胞计数[×10⁹/L,M(Q₁,Q₃)]	1.1(0.7,1.4)	0.9(0.6,1.4)	Z=-0.581	0.561
淋巴细胞[例(构成比,%)]			χ²=1.399	0.237
正常或增加	45(50.56)	11(37.93)
减少	44(49.44)	18(62.07)
CD3亚群[%,M(Q₁,Q₃)]	73.6(67.4,80.9)	66.4(63.9,78.3)	Z=-1.141	0.254
CD4亚群[%,M(Q₁,Q₃)]	39.2(32.7,45.4)	38.4(33.1,49.0)	Z=-0.056	0.955
CD8亚群[%,M(Q₁,Q₃)]	27.5(20.8,34.5)	24.6(20.5,29.3)	Z=-1.664	0.096