免疫系统疾病对γ-干扰素释放试验检测结核感染敏感性的影响

刘增宾; 向伟; 黄咪孙; 孔琳; 许达; 张悦; 牛国超; 张敬蕊; 武娅宁; 李马超; 李桂莲; 王崇

doi:10.3784/jbjc.202503080151

免疫系统疾病对γ-干扰素释放试验检测结核感染敏感性的影响

Influence of immune system disorders on sensitivity of gamma-interferon release assay in detection of M. tuberculosis infection

摘要

摘要:
目的探讨免疫系统疾病对γ-干扰素释放试验（IGRA）检测结核感染敏感性的影响。
方法查阅电子病历纳入2024年1—10月于河北医科大学第二医院进行IGRA（采用结核感染T细胞酶联免疫斑点试验试剂盒）的住院患者，收集年龄、性别，IGRA反应斑点数及阴阳性结果，及类风湿性关节炎、红斑狼疮、溃疡性结肠炎和肾病等免疫系统性疾病的诊断信息。计数资料分析采用χ²检验和多因素logistic回归分析，计量资料分析采用成组秩和检验。
结果共纳入3057人，其中现患结核病125例、具结核病史98例、可疑结核病132例、结核潜伏感染1182例和非结核感染1520例。对2834例无明确结核病（史）患者，多因素logistic回归分析显示，与非免疫系统疾病相比，红斑狼疮组、除类风湿性关节炎和红斑狼疮外的结缔组织病组、溃疡性结肠炎组、混合型免疫系统疾病组和其他单种免疫系统疾病组IGRA阳性的可能性均降低OR值（95%CI）分别为0.55（0.30～1.00）、0.50（0.34～0.73）、0.58（0.40～0.83）、0.53（0.29～0.97）和0.60（0.40～0.90），类风湿性关节炎组和肾病组的IGRA阳性率分别与非免疫系统疾病组相比差异均无统计学意义（P=0.884、0.163）。
结论本研究发现除类风湿性关节炎外的结缔组织病（含红斑狼疮）、溃疡性结肠炎等免疫系统疾病可能提高IGRA试验诊断结核感染的假阴性结果，类风湿性关节炎对IGRA试验敏感性的影响可能较小，以上结果为IGRA在免疫系统疾病患者中的应用提供更多依据。

Abstract:
Objective To evaluate the effect of immune system disorders on the sensitivity of the interferon-gamma release assay (IGRA) in the detection of Mycobacterium tuberculosis infection.
Methods The hospitalized patients who underwent IGRA with T-cell enzyme-linked immune spot test kit for the detection of M. tuberculosis infection in the Second Hospital of Hebei Medical University from January 2024 to October 2024 were included in the study after checking their electronic medical records. The information about the patient’s age, gender, number of reactive spots and negative or positive results of IGRA and the prevalence of immune system disorders, including rheumatoid arthritis, lupus erythematosus, ulcerative colitis, nephropathy, were collected. Enumeration data were analyzed by using χ² test and multivariate logistic regression, while measurement data were analyzed by using the grouped rank sum test.
Results A total of 3057 patients were included, including 125 cases of M. tuberculosis infection, 98 cases with history of M. tuberculosis infection, 132 cases with suspected M. tuberculosis infection, 1182 cases of latent M. tuberculosis infection, and 1520 cases without M. tuberculosis infection. In 2834 patients without definite TB diagnosis (history), multivariate Logistic regression analysis showed that compared with non-immune system disorders, the likelihood of positive IGRA decreased in patients with lupus erythematosus(OR=0.55, 95% CI: 0.30-1.00), connective tissue diseases, except rheumatoid arthritis and lupus erythematosus (OR=0.50, 95% CI: 0.34-0.73), ulcerative colitis (OR= 0.58, 95% CI: 0.40-0.83), mixed immune system disorders (OR=0.53, 95% CI: 0.29-0.97), and other mono-immune system disorders OR=0.60 (95% CI: 0.40-0.90), while the likelihood of positive IGRA was comparable in patients with rheumatoid arthritis (P=0.884) or nephrology disease (P=0.163).
Conclusion Connective tissue diseases (including lupus erythematosus), ulcerative colitis, and other immune system disorders, except rheumatoid arthritis, might increase the possibility of false-negative IGRA in the diagnosis of tuberculosis; rheumatoid arthritis has limited effect on the sensitivity of IGRA. The study results provided useful reference for the application of IGRA in the diagnosis of tuberculosis in patients with immune system disorders.

HTML全文

参考文献(24)

施引文献

资源附件(0)