慢性非免疫系统性疾病对γ-干扰素释放试验检测结核感染敏感性的影响

doi:10.19982/j.issn.1000-6621.20250286

中国防痨杂志 ›› 2025, Vol. 47 ›› Issue (11): 1481-1488.doi: 10.19982/j.issn.1000-6621.20250286

慢性非免疫系统性疾病对γ-干扰素释放试验检测结核感染敏感性的影响

刘增宾¹, 刘佳佳², 武娅宁³, 王亚飞⁴, 许达³, 黄咪孙³, 张敬蕊⁵, 李马超³, 李晓毅¹, 李桂莲³(), 魏会强⁶()

¹河北医科大学第二医院鹿泉院区检验科,石家庄 050000
²河北医科大学第一医院检验中心,石家庄 050000
³传染病溯源预警与智能决策全国重点实验室,中国疾病预防控制中心传染病预防控制所结核病控制室,北京 102206
⁴河北医科大学第二医院鹿泉院区神经内二科,石家庄 050000
⁵石家庄市第四医院检验科,石家庄 050000
⁶河北医科大学第二医院鹿泉院区呼吸科,石家庄 050000

收稿日期:2025-07-09 出版日期:2025-11-10 发布日期:2025-10-30
通信作者: 李桂莲,魏会强 E-mail:liguilian@icdc.cn;weihuiqiang007@163.com
基金资助:
河北省2025年度医学科学研究课题计划项目(20250522)

Effect of chronic non-immune system diseases on the sensitivity of interferon-γ release assay for the detection of tuberculosis infection

Liu Zengbin¹, Liu Jiajia², Wu Yaning³, Wang Yafei⁴, Xu Da³, Huang Misun³, Zhang Jingrui⁵, Li Machao³, Li Xiaoyi¹, Li Guilian³(), Wei Huiqiang⁶()

¹Department of Laboratory Medicine of Luquan Branch, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
²Laboratory Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, China
³National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
⁴Department 2 of Neurosurgery of Luquan Branch, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
⁵Department of Clinical Laboratory, The Fourth Hospital of Shijiazhuang, Shijiazhuang 050000, China
⁶Department of Respiratory of Luquan Branch, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China

Received:2025-07-09 Online:2025-11-10 Published:2025-10-30
Contact: Li Guilian,Wei Huiqiang E-mail:liguilian@icdc.cn;weihuiqiang007@163.com
Supported by:
Hebei Province 2025 Medical Scientific Research Project Plan(20250522)

摘要/Abstract

摘要：

目的: 探讨慢性非免疫系统性疾病对γ-干扰素释放试验(IGRA)检测结核感染敏感性的影响。方法: 采用回顾性研究方法,按照IGRA阳性∶阴性约1∶1的比例从电子病历中分别收集2024年1—10月河北医科大学第二医院住院且相关临床资料(包括有结核病及慢性非免疫系统性疾病临床诊断、IGRA检测结果及斑点数,以及与上述多种疾病密切相关的年龄和性别数据等)完整的3057例患者。排除125例现患结核病和98例有结核病病史的患者后纳入2834例患者作为研究对象,以分析慢性非免疫系统性疾病对IGRA检测结核感染敏感性的影响。结果: 2834例无明确结核感染证据的患者中,男性1534例(54.13%),女性1300例(45.87%);年龄范围为4月龄至98岁,年龄中位数(四分位数)为57.0(37.0,68.0)岁;IGRA阳性和阴性者分别为1300例(45.87%)和1534例(54.13%);合并贫血、低蛋白血症、糖尿病、高血压、乙型病毒性肝炎、肿瘤者分别为531例(18.74%)、591例(20.85%)、541例(19.09%)、965例(34.05%)、96例(3.39%)、709例[25.02%;包括恶性肿瘤393例(55.43%)、疑似恶性肿瘤78例(11.00%)、良性肿瘤238例(33.57%)]。多因素logistic回归分析显示,与女性、未合并糖尿病和0~9岁年龄组相比,男性、合并糖尿病、10~19岁组、20~49岁组和50~98岁组患者IGRA阳性的风险均明显增加[OR(95%CI)值分别为1.773(1.507~2.085)、1.453(1.183~1.785)、3.405(1.143~10.142)、22.070(8.027~60.678)和45.822(16.732~125.486)];与无贫血患者相比,合并贫血患者IGRA阳性的可能性降低[OR(95%CI)=0.591(0.477~0.732)]。结论: 贫血可能会导致IGRA检测结核感染的假阴性结果,而糖尿病则可能导致假阳性结果或致结核感染的可能性升高,提示临床应对上述合并症患者的IGRA结果谨慎解读,避免误诊。

关键词: 分枝杆菌感染, 干扰素γ, 免疫学试验, 慢性病, 共病现象

Abstract:

Objective: To investigate the effect of chronic non-immune system diseases on the sensitivity of interferon-gamma release assay (IGRA) for detection of tuberculosis (TB) infection. Methods: A retrospective study was conducted. Electronic medical records of inpatients at the Second Hospital of Hebei Medical University from January to October 2024 were collected. A total of 3057 inpatients with complete clinical data were selected, following an approximate 1∶1 ratio of IGRA-positive to IGRA-negative cases. The data included clinical diagnosis of TB or chronic non-immunological diseases, IGRA results, and spot-forming cell counts, as well as age and gender data closely related to the above diseases. After excluding 125 patients with active TB and 98 with a history of TB, 2834 patients were included to analyze the effect of chronic non-immune diseases on the sensitivity of IGRA for detection of TB infection. Results: Among the 2834 patients without definitive evidence of TB infection, 1534 (54.13%) were male and 1300 (45.87%) were female, with an age range of 4 months to 98 years (median (IQR): 57.0 (37.0, 68.0) years). There were 1300 (45.87%) IGRA-positive and 1534 (54.13%) IGRA-negative cases. Patients with comorbidities included anemia (531, 18.74%), hypoalbuminemia (591, 20.85%), diabetes (541, 19.09%), hypertension (965, 34.05%), hepatitis B (96, 3.39%), and tumors (709, 25.02%). Among tumor cases, 393 (55.43%) were malignant tumors, 78 (11.00%) were suspected malignancies, and 238 were (33.57%) benign tumors. Multivariate logistic regression analysis showed that, compared to females, non-diabetics, and the 0-9 years age group, the risk of a positive IGRA was significantly increased in males, patients with diabetes, and those in the 10-19, 20-49, and 50-98 years age groups (OR (95%CI): 1.773 (1.507-2.085), 1.453 (1.183-1.785), 3.405 (1.143-10.142), 22.070 (8.027-60.678), and 45.822 (16.732-125.486), respectively). Conversely, patients with anemia had a decreased likelihood of a positive IGRA compared to non-anemic patients (OR (95%CI)=0.591 (0.477-0.732)). Conclusion: Anemia may lead to the false-negative results of the IGRA test, whereas diabetes mellitus may lead to the false positivity or increased TB infection. These findings suggest that IGRA results should be interpreted cautiously in patients with these comorbidities to avoid misdiagnosis.

Key words: Tuberculosis infection, Interferon-gamma, Immunologic tests, Chronic disease, Comorbidities

中图分类号:

刘增宾, 刘佳佳, 武娅宁, 王亚飞, 许达, 黄咪孙, 张敬蕊, 李马超, 李晓毅, 李桂莲, 魏会强. 慢性非免疫系统性疾病对γ-干扰素释放试验检测结核感染敏感性的影响[J]. 中国防痨杂志, 2025, 47(11): 1481-1488. doi: 10.19982/j.issn.1000-6621.20250286

Liu Zengbin, Liu Jiajia, Wu Yaning, Wang Yafei, Xu Da, Huang Misun, Zhang Jingrui, Li Machao, Li Xiaoyi, Li Guilian, Wei Huiqiang. Effect of chronic non-immune system diseases on the sensitivity of interferon-γ release assay for the detection of tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2025, 47(11): 1481-1488. doi: 10.19982/j.issn.1000-6621.20250286

图/表 4

表1

表2

表3

影响慢性非免疫系统性疾病患者IGRA阳性的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Z值	P值	OR(95%CI)值
性别
女性			参考	参考
男性	0.573	0.083	47.849	<0.001	1.773(1.507~2.085)
年龄组(岁)
0~9			参考	参考
10~19	1.225	0.557	4.840	0.028	3.405(1.143~10.142)
20~49	3.094	0.516	35.956	<0.001	22.070(8.027~60.678)
50~98	3.825	0.514	55.370	<0.001	45.822(16.732~125.486)
贫血
是	-0.526	0.110	23.100	<0.001	0.591(0.477~0.732)
否			参考	参考
高血压
是	-0.067	0.089	0.572	0.450	0.935(0.786~1.113)
否			参考	参考
低蛋白血症
是	0.000	0.104	0.000	0.999	1.000(0.816~1.226)
否			参考	参考
糖尿病
是	0.374	0.105	12.671	<0.001	1.453(1.183~1.785)
否			参考	参考
肿瘤
恶性肿瘤	-0.191	0.117	2.670	0.102	0.826(0.656~1.039)
疑似恶性肿瘤	0.473	0.246	3.711	0.054	1.606(0.992~2.599)
良性肿瘤	0.169	0.145	1.364	0.243	1.184(0.892~1.574)
非肿瘤			参考	参考

表3

表4

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特征	IGRA		合计 (2834例)	χ²值	P值
特征	阳性(1300例)	阴性(1534例)	合计 (2834例)	χ²值	P值
性别				52.014	<0.001
男性	799(52.09)	735(47.91)	1534(54.13)
女性	501(38.54)	799(61.46)	1300(45.87)
年龄组(岁)				302.932	<0.001
0~9	4(3.25)	119(96.75)	123(4.34)
10~19	22(9.73)	204(90.27)	226(7.97)
20~49	273(37.97)	446(62.03)	719(25.37)
50~98	1001(56.68)	765(43.32)	1766(2.32)

因素	合计 (例)	IGRA[例数(构成比,%)]		χ²值	P值
因素	合计 (例)	阳性(1300例)	阴性(1534例)	χ²值	P值
贫血				15.468	<0.001
是	531	203(38.23)	328(61.77)
否	2303	1097(47.63)	1206(52.37)
乙型病毒性肝炎				2.166	0.097
是	96	52(54.17)	44(45.83)
否	2738	1248(45.58)	1490(54.42)
高血压				20.807	<0.001
是	965	500(51.81)	465(48.19)
否	1869	800(42.80)	1069(57.20)
低蛋白血症				5.338	0.021
是	591	296(50.08)	295(49.92)
否	2243	1004(44.76)	1239(55.24)
糖尿病				18.495	<0.001
是	541	293(54.16)	248(45.84)
否	2293	1007(43.92)	1286(56.08)
肿瘤				17.081	<0.001
恶性肿瘤	393	190(48.35)	203(51.65)
疑似恶性肿瘤	78	49(62.82)	29(37.18)
良性肿瘤	238	125(44.05)	113(55.95)
无肿瘤	2125	936(45.87)	1189(54.13)

因素	例数			斑点个数[中位数(四分位数)]	Z值	P值
贫血					1.256	0.209
是	203			28.0(11.0,56.0)
否	1097			29.0(12.0,76.0)
低蛋白血症					0.755	0.451
是	296			28.0(11.0,66.0)
否	1004			29.0(12.0,75.0)
糖尿病					1.776	0.076
是	293			31.0(12.0,86.0)
否	1007			28.0(11.0,69.0)
高血压					0.163	0.870
是	500			29.0(11.3,77.0)
否	800			28.5(12.0,71.0)
乙型病毒性肝炎					1.642	0.101
是	58			45.0(13.0,83.0)
否	1242			28.0(11.8,72.0)
肿瘤					4.174	0.244
恶性肿瘤		190	26.0(10.0,56.5)
疑似恶性肿瘤		49	33.0(12.5,62.5)
良性肿瘤		125	35.0(14.0,66.5)
非肿瘤		936	28.0(11.0,78.0)

慢性非免疫系统性疾病对γ-干扰素释放试验检测结核感染敏感性的影响

Effect of chronic non-immune system diseases on the sensitivity of interferon-γ release assay for the detection of tuberculosis infection

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