γ-干扰素诱导蛋白-10 mRNA检测试验对不同年龄人群结核病的辅助诊断价值

doi:10.19982/j.issn.1000-6621.20230351

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (2): 221-227.doi: 10.19982/j.issn.1000-6621.20230351

γ-干扰素诱导蛋白-10 mRNA检测试验对不同年龄人群结核病的辅助诊断价值

宋瑞雪, 董静, 姚明旭, 贾红彦, 李自慧, 孙琦, 朱传智, 杜博平, 邢爱英, 潘丽萍()

耐药结核病研究北京市重点实验室/首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所, 北京 101149

收稿日期:2023-09-28 出版日期:2024-02-10 发布日期:2024-01-30
通信作者: 潘丽萍 E-mail:panliping2006@163.com
基金资助:
北京市自然科学基金(7212012);北京市自然科学基金(L234055);通州区科技计划项目(KJ2022CX042);北京市医院管理中心青年职工创新工作室-创新梦工场(202136);国家自然科学基金(82172279);国家自然科学基金(82070012);通州区运河计划人才项目(YH201807);通州区运河计划人才项目(YH202001)

Auxiliary diagnosis value of interferon gamma-induced protein 10 mRNA release assay for tuberculosis in different age groups

Song Ruixue, Dong Jing, Yao Mingxu, Jia Hongyan, Li Zihui, Sun Qi, Zhu Chuanzhi, Du Boping, Xing Aiying, Pan Liping()

Beijing Key Laboratory for Drug Resistant Tuberculosis Research/Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China

Received:2023-09-28 Online:2024-02-10 Published:2024-01-30
Contact: Pan Liping E-mail:panliping2006@163.com
Supported by:
Beijing Natural Science Foundation(7212012);Beijing Natural Science Foundation(L234055);Tongzhou Science and Technology Project(KJ2022CX042);Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support(202136);National Natural Science Foundation of China(82172279);National Natural Science Foundation of China(82070012);Tongzhou Yunhe Project(YH201807);Tongzhou Yunhe Project(YH202001)

摘要/Abstract

摘要： 目的: 探讨γ-干扰素诱导蛋白-10(interferon gamma-induced protein 10,IP-10) mRNA检测技术对不同年龄组结核病患者的辅助诊断价值。方法: 前瞻性纳入2018年3月至2022年7月在首都医科大学附属北京胸科医院、河南省传染病医院和深圳市第三人民医院收治、且完成IP-10 mRNA检测的疑似结核病患者1590例。剔除诊断不明确200例,共1390例纳入分析。根据诊断结果分为确诊结核病组(475例)、临床诊断结核病组(518例)、非结核病组(397例)。按照年龄将入组患者分为中青年组(18~59岁)1062例和老年组(60~95岁)328例。在不同年龄组中,以临床诊断结果为标准,分析IP-10 mRNA检测对结核病的诊断效能。结果: 中青年组IP-10 mRNA检测的敏感度和特异度分别为90.2%(721/799,95%CI:87.9%~92.1%)和68.8%(170/247, 95%CI:62.6%~74.4%),老年组IP-10 mRNA 检测的敏感度和特异度分别为87.8%(159/181,95%CI:82.0%~92.0%)和54.7%(76/139,95%CI:46.0%~63.1%)。两个年龄组间IP-10 mRNA 检测的敏感度比较差异无统计学意义(χ²=0.922,P=0.337),但中青年组IP-10 mRNA 检测的特异度高于老年组,差异有统计学意义(χ²=7.704,P=0.006)。随年龄增长,IP-10 mRNA检测的敏感度的变化差异无统计学意义(Z=-1.063,P=0.288),特异度随年龄增长明显降低(Z=-2.846,P=0.004)。 结论: IP-10 mRNA检测对中青年结核病患者的辅助诊断更有价值;考虑IP-10 mRNA检测的敏感度受年龄影响较小,可能有助于在老年人群中应用该技术进行结核感染的主动筛查。

关键词: 结核, 诊断,鉴别, 干扰素类, 干扰素诱导剂

Abstract: Objective: To evaluate the auxiliary value of interferon gamma-induced protein 10 (IP-10) mRNA release assay in the diagnosis for tuberculosis in different age groups. Methods: Totally 1590 suspected tuberculosis patients who were admitted to the Beijing Chest Hospital, Henan Infectious Diseases Hospital, and the Third People’s Hospital of Shenzhen from March 2018 to July 2022 and who finished IP-10 mRNA release assay before anti-tuberculosis therapy were prospectively recruited. A total of 1390 cases were included in the final analysis, and were divided into definite TB group (n=475), probable TB group (n=518) and non-TB group (n=397), according to the clinical diagnosis results. Other 200 cases with unclear diagnosis were excluded from the analysis. Furthermore, all the patients included in the analysis were further divided into two groups according to the age, the younger group (n=1062, 18-59 years) and the elderly group (n=328, 60-95 years). The diagnostic performance of IP-10 mRNA release assay were analyzed in the different age groups, based on the final diagnosis in clinic. Results: The sensitivity and specificity of IP-10 mRNA release assay were 90.2% (721/799, 95%CI: 87.9%-92.1%) and 68.8% (170/247, 95%CI: 62.6%-74.4%), respectively in the younger group, while 87.8% (159/181, 95%CI: 82.0%-92.0%) and 54.7% (76/139, 95%CI: 46.0%-63.1%), respectively in the elderly group. The specificity of IP-10 mRNA release assay in the younger group was significantly higher than that in the elderly group (χ²=7.704, P=0.006). However, there were no significant difference in the sensitivity between the two groups (χ²=0.922, P=0.337). There was no significant difference in the trend of diagnostic sensitivity of IP-10 mRNA release assay with the increasing age (Z=-1.063, P=0.288), but the diagnostic specificity was decreased significantly with the increasing age (Z=-2.846, P=0.004). Conclusion: IP-10 mRNA release assay is a promising test for auxiliary diagnosis of tuberculosis in younger patients; while considering the less impact of age on diagnostic sensitivity of IP-10 mRNA release assay, it may be helpful to use this technique for screening Mycobacterium tuberculosis infection in the elderly population.

Key words: Tuberculosis, Diagnosis, differential, Interferons, Interferon inducers

中图分类号:

R52
R825.2

宋瑞雪, 董静, 姚明旭, 贾红彦, 李自慧, 孙琦, 朱传智, 杜博平, 邢爱英, 潘丽萍. γ-干扰素诱导蛋白-10 mRNA检测试验对不同年龄人群结核病的辅助诊断价值[J]. 中国防痨杂志, 2024, 46(2): 221-227. doi: 10.19982/j.issn.1000-6621.20230351

Song Ruixue, Dong Jing, Yao Mingxu, Jia Hongyan, Li Zihui, Sun Qi, Zhu Chuanzhi, Du Boping, Xing Aiying, Pan Liping. Auxiliary diagnosis value of interferon gamma-induced protein 10 mRNA release assay for tuberculosis in different age groups[J]. Chinese Journal of Antituberculosis, 2024, 46(2): 221-227. doi: 10.19982/j.issn.1000-6621.20230351

图/表 4

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特征	确诊结核病组(475例)	临床诊断结核病组(518例)	非结核病组(397例)
年龄[岁,M(Q₁,Q₃)]	41(18,88)	37(18,95)	53(18,88)
性别[例(构成比,%)]
男性	317(66.7)	300(57.9)	232(58.4)
女性	158(33.3)	218(42.1)	165(41.6)
合并症[例(发生率,%)]
糖尿病	95(20.0)	39(7.5)	38(9.6)
高血压	38(8.0)	35(6.8)	57(14.4)
HIV感染	14(2.9)	-	38(9.6)
其他免疫系统疾病	11(2.3)	4(0.8)	4(1.0)
免疫抑制剂使用	16(3.4)	6(1.2)	-
肺结核[例(构成比,%)]	448(94.3)	468(90.3)	-
肺外结核[例(构成比,%)]	27(5.7)	50(9.7)	-
骨关节结核	18(3.8)	19(3.7)	-
淋巴结结核	1(0.2)	16(3.1)	-
泌尿生殖系统结核	3(0.7)	7(1.3)	-
结核性脑膜炎	2(0.4)	3(0.6)	-
支气管结核	2(0.4)	-	-
肠结核	1(0.2)	5(1.0)	-
耐药结核病[例(构成比,%)]	27(5.7)	5(1.0)	-
非结核病[例(构成比,%)]	-	-	-
肺癌	-	-	139(35.0)
肺炎	-	-	179(45.1)
非结核分枝杆菌病	-	-	42(10.6)
其他	-	-	37(9.3)

组别	临床诊断		敏感度 [%(95%CI)]	特异度 [%(95%CI)]	阳性预测值 [%(95%CI)]	阴性预测值 [%(95%CI)]	阳性似然比 (95%CI)	阴性似然比 (95%CI)
组别	结核病组	非结核病组	敏感度 [%(95%CI)]	特异度 [%(95%CI)]	阳性预测值 [%(95%CI)]	阴性预测值 [%(95%CI)]	阳性似然比 (95%CI)	阴性似然比 (95%CI)
中青年组(18~59岁)			90.2 (87.9~92.1)	68.8 (62.6~74.4)	90.4 (88.0~92.2)	68.5 (62.3~74.1)	2.89 (2.40~3.49)	0.14 (0.11~0.18)
阳性	721	77
阴性	78	170
老年组(60~95岁)			87.8 (82.0~92.0)	54.7 (46.0~63.1)	71.6 (65.1~77.3)	77.6 (67.8~85.1)	1.94 (1.60~2.34)	0.22 (0.15~0.33)
阳性	159	63
阴性	22	76

γ-干扰素诱导蛋白-10 mRNA检测试验对不同年龄人群结核病的辅助诊断价值

Auxiliary diagnosis value of interferon gamma-induced protein 10 mRNA release assay for tuberculosis in different age groups

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