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目的评价结核菌素(PPD)皮试和全血γ干扰素(IFN-γ)测定试验诊断儿童结核病的准确性。方法选择2006年7月至2010年4月首都医科大学附属北京儿童医院住院临床诊断结核和呼吸系统疾病的患儿为研究对象。根据患儿所暴露的结核感染危险因素分为5组:A组:无结核病密切接触史的非结核病的呼吸系统疾病患儿;B组:有活动性结核病患者密切接触史的非结核病的呼吸系统疾病患儿;C组:无结核病密切接触史的临床诊断结核病患儿;D组:有活动性结核病患者密切接触史的临床诊断结核病患儿;E组:病原学或病理学确诊的活动性结核病患儿。患儿于入院当日行PPD皮试,入院后1~7 d采集外周静脉血行全血IFN-γ测定。以敏感度、特异度、阴性预测值、阳性预测值和似然比评价PPD皮试和全血IFN-γ测定对结核病的诊断价值。结果125例患儿进入分析。A组40例,B组11例,C组29例,D组27例,E组18例。①PPD皮试取硬结≥10 mm为阳性判断标准时,诊断结核病的敏感度为77.0%,特异度为70.6%;取硬结≥15mm为阳性判断标准时,诊断结核病的敏感度为50.0%、特异度为80.2%;全血IFN-γ测定的敏感度为85.1%、特异度为94.1%。②PPD皮试取硬结≥10 mm为阳性判断标准诊断结核病时,<3岁患儿PPD皮试的敏感度和特异度均显著低于≥3岁患儿,城区和郊区患儿的敏感度和特异度接近;全血IFN-γ测定诊断结核病的敏感度和特异度在不同年龄、居住地间差异无统计学意义。③全血IFN-γ测定阳性率与结核感染暴露因素的相关性优于PPD皮试(取硬结≥10或15 mm为阳性判断标准时)。结论潜伏结核感染筛查时以硬结≥15 mm作为PPD皮试阳性判断标准,可提高诊断的特异度;临床疑似结核病的诊断以硬结≥10 mm作为PPD皮试阳性判断标准,可提高诊断的敏感度。全血IFN-γ测定诊断结核病的敏感度和特异度均较好。
Objective To evaluate the diagnostic accuracy of tuberculin (PPD) skin test and whole blood interferon gamma (IFN-γ) test in the diagnosis of childhood tuberculosis. Methods From July 2006 to April 2010, Beijing Children’s Hospital Affiliated to Capital Medical University, hospitalized patients with clinical diagnosis of tuberculosis and respiratory diseases as the research object. According to the risk factors of tuberculosis infection exposed to children are divided into 5 groups: A group: non-tuberculosis close contact history of children with non-tuberculosis respiratory disease; B group: active TB patients with close contact history of non-tuberculosis respiratory system Children with disease; Group C: children with tuberculosis without clinical diagnosis of TB; children with tuberculosis: Group D with clinical diagnosis of TB with close contact history of active tuberculosis; Group E: children with active tuberculosis with pathogenic or pathologically confirmed TB Children. Children on the day of admission line PPD skin test, admission 1 to 7 d peripheral blood venous blood samples were collected for determination of IFN-γ. The sensitivity, specificity, negative predictive value, positive predictive value and likelihood ratio were used to evaluate the diagnostic value of PPD skin test and whole blood IFN-γ test in tuberculosis. Results 125 children entered the analysis. 40 cases in group A, 11 cases in group B, 29 cases in group C, 27 cases in group D and 18 cases in group E. ①The PPD skin test showed that the sensitivity of tuberculosis diagnosis was 77.0% and the specificity was 70.6% when the incidence of induration ≥ 10 mm was positive. The sensitivity and specificity of diagnosing tuberculosis were 50.0% and 80.2 %; The sensitivity of the whole blood IFN-γ assay was 85.1% with a specificity of 94.1%. ② PPD skin test hardened ≥ 10 mm positive diagnostic criteria for the diagnosis of tuberculosis, <3-year-old children with PPD skin test sensitivity and specificity were significantly lower than 3-year-old children, urban and suburban children with sensitivity and specificity Degree of closeness; the sensitivity and specificity of whole blood IFN-γ test in diagnosing tuberculosis have no statistical significance in different age and residence. ③ The correlation between the positive rate of IFN-γ in whole blood and exposure factors of tuberculosis infection is better than that of PPD skin test (when the nodule is ≥10 or 15 mm, it is positive). Conclusion Clinically latent tuberculous infection screening with sclerosis ≥ 15 mm as PPD skin test positive criteria can improve the diagnosis of specificity; clinical suspicion of tuberculosis diagnosis of induration of ≥ 10 mm PPD skin test as a positive diagnostic criteria, can improve the diagnostic sensitivity degree. The sensitivity and specificity of whole blood IFN-γ assay to diagnose tuberculosis are better.