CAJ | 학술논문

目的：探讨γ-干扰素对老年结核性胸膜炎的诊断价值。方法将2012年3月至2014年5月在我院就诊的胸腔积液患者86例，分为结核组（结核性胸膜炎52例）和对照组（非结核性胸膜炎34例）。对所有患者的胸积液进行 IFN-γ浓度、ADA 活性以及 LAM-IgG 阳性率检测；分析三种诊断方案对老年结核性胸膜炎诊断的敏感性、特异性和准确性。结果结核组患者胸腔积液的 IFN-γ浓度、ADA 活性以及 LAM-IgG 阳性率均显著高于对照组，差异均具有统计学意义（P ＜0．05）。IFN-γ检测对老年结核性胸膜炎诊断的敏感性为86．5％，高于 ADA 检测，显著高于LAM-IgG 阳性率检测（P ＜0．05）；IFN-γ诊断的准确性高于其他两种诊断方法，但差异不显著（P ＞0．05）；三种诊断方法的特异性差异不显著。IFN-γ和 ADA 检测的 ROC 曲线下面积分别0．907和0．845。三种方法联用对结核性胸膜炎诊断的敏感度为69．2％（36／52），特异性为100％（34／34）。结论IFN-γ检测胸腔积液是一种较为准确的诊断老年结核性胸膜炎的方法，与 ADA 活性和 LAM-IgG 阳性率联合检测可提高诊断的特异性。
목적：탐토γ-간우소대노년결핵성흉막염적진단개치。방법장2012년3월지2014년5월재아원취진적흉강적액환자86례，분위결핵조（결핵성흉막염52례）화대조조（비결핵성흉막염34례）。대소유환자적흉적액진행 IFN-γ농도、ADA 활성이급 LAM-IgG 양성솔검측；분석삼충진단방안대노년결핵성흉막염진단적민감성、특이성화준학성。결과결핵조환자흉강적액적 IFN-γ농도、ADA 활성이급 LAM-IgG 양성솔균현저고우대조조，차이균구유통계학의의（P ＜0．05）。IFN-γ검측대노년결핵성흉막염진단적민감성위86．5％，고우 ADA 검측，현저고우LAM-IgG 양성솔검측（P ＜0．05）；IFN-γ진단적준학성고우기타량충진단방법，단차이불현저（P ＞0．05）；삼충진단방법적특이성차이불현저。IFN-γ화 ADA 검측적 ROC 곡선하면적분별0．907화0．845。삼충방법련용대결핵성흉막염진단적민감도위69．2％（36／52），특이성위100％（34／34）。결론IFN-γ검측흉강적액시일충교위준학적진단노년결핵성흉막염적방법，여 ADA 활성화 LAM-IgG 양성솔연합검측가제고진단적특이성。
Objective To evaluate the diagnostic value of interferon-γ (IFN-γ)in elderly patients with tuberculous pleurisy.Methods 86 elderly patients with pleural fluid in our hospital between Mar 2012 and May 2014 were pleural tuberculosis group (52 cases with tuberculous pleurisy)and control group (34 cases non-pleural tuberculosis).The lev-el of IFN-γ,ADA activity and LAM-IgG positive rate in pleural fluid were measured,to analyze sensitivity,specificity and accuracy in the diagnosis of elderly patients with tuberculous pleurisy.Results The level of IFN-γ,ADA activity and LAM-IgG positive rate of patients in pleural tuberculosis group were significantly higher than control group (P <0.05).The sensitivity of IFN-γin diagnosing tuberculous pleural was 86.5%,higher than ADA,and significantly high-er than LAM-IgG (P <0.05).The accuracy of IFN-γwas slightly higher than ADA and LAM-IgG (P >0.05).There was no significant difference in specificity of three methods.The area under the ROC curve was 0.907 for IFN-γ and 0.845 for ADA.The sensitivity of combination diagnosis of IFN-γ,ADA and LAM-IgG was 69.2% (36/52),and the specificity increased to 100% (34/34).Conclusion Interferon-gamma release assay is a relatively accurate diagnosis of pleural tuberculosis,and the combination of IFN-γ,ADA and LAM-IgG is of diagnostic value.