CAJ | 학술논문

目的：探讨在胸水中检测抗原诱发的γ-干扰素释放反应（ IGRA）在结核性胸膜炎中的诊断价值。方法选取河南省胸科医院胸腔积液患者65例，根据胸膜活检病理结果分为结核组（35例）与肿瘤组（30例），应用酶联免疫吸附试验（ ELISA）检测两组患者血清及胸水中γ-干扰素基础值及经ESAT-6抗原刺激后γ-干扰素释放水平，并对数据进行对比分析，判断γ-干扰素基础值及经ESAT-6抗原刺激后γ-干扰素释放水平对结核性胸膜炎的诊断价值。结果结核组胸水中的γ-干扰素基础值和经ESAT-6抗原刺激后γ-干扰素释放水平均高于血中的γ-干扰素基础值及经ESAT-6抗原刺激后γ-干扰素释放水平，差异有统计学意义（P﹤0.01）。结核组胸水中的γ-干扰素基础值和经ESAT-6抗原刺激后γ-干扰素释放水平均高于恶性胸腔积液组，差异有统计学意义（ P﹤0.05）。结核组血中检测γ-干扰素基础值及经ESAT-6抗原刺激后γ-干扰素释放水平均高于肿瘤组，但差异无统计学意义（ P﹥0.05）。结论结核高感染率的背景下，血中IGRA对于鉴别胸腔积液是肿瘤还是结核意义不大；在胸水中检测IGRA对结核性胸膜炎诊断的方法简便，特异性、灵敏度高，在临床上值得推广使用。
목적：탐토재흉수중검측항원유발적γ-간우소석방반응（ IGRA）재결핵성흉막염중적진단개치。방법선취하남성흉과의원흉강적액환자65례，근거흉막활검병리결과분위결핵조（35례）여종류조（30례），응용매련면역흡부시험（ ELISA）검측량조환자혈청급흉수중γ-간우소기출치급경ESAT-6항원자격후γ-간우소석방수평，병대수거진행대비분석，판단γ-간우소기출치급경ESAT-6항원자격후γ-간우소석방수평대결핵성흉막염적진단개치。결과결핵조흉수중적γ-간우소기출치화경ESAT-6항원자격후γ-간우소석방수평균고우혈중적γ-간우소기출치급경ESAT-6항원자격후γ-간우소석방수평，차이유통계학의의（P﹤0.01）。결핵조흉수중적γ-간우소기출치화경ESAT-6항원자격후γ-간우소석방수평균고우악성흉강적액조，차이유통계학의의（ P﹤0.05）。결핵조혈중검측γ-간우소기출치급경ESAT-6항원자격후γ-간우소석방수평균고우종류조，단차이무통계학의의（ P﹥0.05）。결론결핵고감염솔적배경하，혈중IGRA대우감별흉강적액시종류환시결핵의의불대；재흉수중검측IGRA대결핵성흉막염진단적방법간편，특이성、령민도고，재림상상치득추엄사용。
Objective To investigate the diagnostic value of pleural fluid interferon-gamma re-lesse assay( IGRA)on tuberculous pleurisy. Methods According to the pathological results of pleural biopsy,65 patients with plearal effusion were divided into two groups:tuberculous pleurisy group(35 ca-ses)and malignant pleural effusion group(30 cases). Enzyme-linked immunosorbent assay( enzyme linked immunosorbent assay,ELISA)method was used to detect the serum and pleural interferon-γbase level and the interferon-γ release level after ESAT-6 antigen stimulation,the value of interferon-γ base value and interferon-γ release level after the ESAT-6 antigen stimulation on the diagnosis of tuberculous pleuritis was evaluated. Results In tuberculous pleurisy patients,the interferon-γbase value and inter-feron-γ release after the ESAT-6 antigen stimulation was higher than blood interferon-γ basic values and interferon-γ release level after ESAT-6 antigen stimulation(P﹤0. 01). In tuberculous pleurisy patients, the interferon-γbase value and interferon-γrelease after the ESAT-6 antigen stimulation were higher than that with malignant pleural effusion group(P﹤0. 05). In tuberculous pleurisy patients,the blood inter-feron-γ base value and the interferon-γ release after ESAT-6 antigen stimulation were higher than that of malignant pleural effusion group( P﹥0. 05 ). Conclusions In the background of hight rate of tuberculo-sis infection,there is no specificity of interferon-γ release assay( IGRA)in diagnosis of patients with tumor. Interferon-γ release assay( IGRA)in the diagnosis of tuberculous pleurisy is simple,sensitive, has high specificity and worthy of clinical application.