结核分枝杆菌感染检测两步法在学校结核病筛查中的应用价值

doi:10.19982/j.issn.1000-6621.20220096

摘要/Abstract

摘要：

目的: 初步评估结核菌素皮肤试验(TST)联合γ-干扰素释放试验(IGRA)(简称“两步法”)检测在学生健康体检中筛查结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染和活动性肺结核的应用价值。方法: 采用横断面研究的方法,选取2017—2021年广东省74358名学生作为研究对象,其中50701(68.18%)名完成了胸部X线摄片(简称“胸片”)筛查,74148名(99.72%)完成了TST筛查;9702(13.08%)名TST检测阳性者进一步完成了IGRA检测。最后对胸片异常、TST和IGRA检测“双阳者”完善肺结核相关检查。结果: 以IGRA检测结果为参照标准,分别以TST检测硬结平均直径为5、10和15mm为阳性临界值,TST与IGRA检测MTB感染的一致率分别为15.97%(1549/9702)、26.63%(2584/9702)、81.11%(7869/9702),Kappa值分别为0.014、0.014和0.112。TST检测MTB感染率[11.67%(8652/74148)]明显高于两步法[1.02%(759/74148)],差异有统计学意义(χ²=7068.423,P<0.001)。对TST中阳和强阳者完善结核病相关检查后的肺结核检出率[0.29%(15/5219)]明显低于对“双阳者”的检出率[1.84%(14/759)],差异有统计学意义(χ²=30.133,P<0.001)。结论: TST和IGRA检测MTB感染的一致性较差,“两步法”可明显提高MTB感染的精准性和肺结核患者筛查效率。

关键词: 分枝杆菌,结核, 结核菌素试验, 多相筛查, 学校

Abstract:

Objective: To evaluate the application value of tuberculin skin test (TST) combined with interferon-gamma release assays (IGRA)(shorter form“two-step”) screening Mycobacterium tuberculosis (MTB) infection and active tuberculosis in students’ physical examination. Methods: A cross-sectional study was conducted in 74358 students in Guangdong during 2017—2021, 50701 (68.18%) were treated with chest X-ray and 74148 (99.72%) were tested with TST. And then, 9702 (13.08%) students positive in TST test received IGRA test (two-step approach). Finally, the students with abnormal chest X-ray and those who were positive in TST and IGRA tests (double positive) should be further examined to clarify the diagnosis of pulmonary tuberculosis. Results: Using the IGRA test results as the reference standard,taking the mean diameter of induration detected by TST of 5, 10 and 15 mm as the positive threshold, the consistency rates of MTB infection detected by TST and IGRA were 15.97% (1549/9702), 26.63% (2584/9702) and 81.11% (7869/9702), respectively, with the Kappa values of 0.014, 0.014 and 0.112, respectively. The rate of MTB infection detected by TST was significantly higher than that of the two-step method (11.67% (8652/74148) vs. 1.02% (759/74148), χ²=7068.423,P<0.001). The detection rate of pulmonary tuberculosis among students with moderate and strongly positive TST was significantly lower than that among students with double positive (0.29% (15/5219) vs. 1.84% (14/759), χ²=30.133,P<0.001). Conclusion: The consistency of detecting MTB infection by TST and IGRA is poor. The “two-step method” can significantly improve the detection rate of MTB infection and the screening efficiency of pulmonary tuberculosis in schools.

Key words: Mycobacterium tuberculosis, Tuberculin test, Multiphasic screening, School

中图分类号:

R521
R181.2

董小伟, 郭卉欣, 张晨晨, 王嘉雯, 何俊磊, 李观海, 李建伟, 温文沛. 结核分枝杆菌感染检测两步法在学校结核病筛查中的应用价值[J]. 中国防痨杂志, 2022, 44(8): 802-807. doi: 10.19982/j.issn.1000-6621.20220096

Dong Xiaowei, Guo Huixin, Zhang Chenchen, Wang Jiawen, He Junlei, Li Guanhai, Li Jianwei, Wen Wenpei. Application value of two-step detection of Mycobacterium tuberculosis infection screening in schools[J]. Chinese Journal of Antituberculosis, 2022, 44(8): 802-807. doi: 10.19982/j.issn.1000-6621.20220096

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参考文献 21

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学校类型	TST检测[名(比率,%)]					IGRA检测[名/例(比率,%)]
学校类型	检查人数	强阳性	中度阳性	一般阳性	阴性	检查人数	阳性	阴性
初中	15365	340(2.21)	2502(16.28)	5489(35.73)	7034(45.78)	2793	146(5.23)	2647(94.77)
职高、高中等	40796	793(1.94)	3467(8.50)	7077(17.35)	29459(72.21)	4930	487(9.88)	4443(90.12)
大专、大学等	17987	408(2.27)	1142(6.35)	1816(10.09)	14621(81.29)	1979	254(12.83)	1725(87.17)

TST检测阳性临界值	IGRA		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	一致率 (%)	Kappa(95%CI)值
TST检测阳性临界值	阳性(例)	阴性(名)	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	一致率 (%)	Kappa(95%CI)值
5mm~			99.55	7.56	9.78	99.40	15.97	0.014(0.012~0.016)
阳性	883	8149
阴性	4	666
10mm~			85.57	20.70	9.79	93.45	26.63	0.014(0.008~0.020)
阳性	759	6990
阴性	128	1825
15mm~			27.85	86.47	17.15	92.25	81.11	0.112(0.088~0.136)
阳性	247	1193
阴性	640	7622

指标	TST检测			两步法检测			χ²值	P值
指标	TST中阳	TST强阳	小计	TST中阳+ IGRA阳	TST强阳+ IGRA阳	小计	χ²值	P值
MTB感染例数	7111	1541	8652	512	247	759	7068.423	<0.001
感染率(%)	9.59	2.08	11.67	0.69	0.33	1.02

指标	TST筛查			两步法
指标	TST中阳	TST强阳	小计	TST中阳+IGRA阳	TST强阳+IGRA阳	小计
检查学生人数	4014	1205	5219	512	247	759
肺结核患者例数	7	8	15	7	7	14
检出率(%)	0.17	0.66	0.29	1.37	2.83	1.84