中文摘要：

目的 探讨结核分枝杆菌特异性γ干扰素释放试验（interferon gamma release assays,IGRAs）在鉴别诊断肺结核和非结核分枝杆菌（non-tuberculous mycobacteria,NTM）肺病中的应用价值.方法 选择深圳市第三人民医院2011年1月至2013年5月334例收住于肺科住院部感染了分枝杆菌的肺病患者.采用反向斑点杂交技术对334例分枝杆菌感染的肺病患者痰培养分离的分枝杆菌进行菌种鉴定;采用IGRAs测定患者外周血结核分枝杆菌抗原特异性γ干扰素（IFN-γ）应答;采用结核分枝杆菌特异性荧光定量PCR技术检测痰标本中结核分枝杆菌DNA.结果 在334例分枝杆菌感染的患者中,240例的菌株为结核分枝杆菌,94例为NTM; 240例肺结核患者中痰结核分枝杆菌DNA PCR检测阳性率为74.58％（179/240）,IGRAs检测阳性率为77.08％（185/240）;94例NTM肺病患者中,结核分枝杆菌DNA PCR检测阳性率为10.64％（10/94）,IGRAs检测阳性率为20.21％（19/94）.结核分枝杆菌DNA PCR和IGRAs检测鉴别诊断肺结核和NTM肺病的敏感度分别为74.58％（179/240）、77.08％（185/240）,特异度分别为89.36％（84/94）、79.79％（75/94）;两种方法联合检测肺结核的敏感度为%.75％（225/240）、特异度为77.66％（73/94）.结论 IGRAs对于鉴别肺结核和NTM肺病具有较好的应用价值,联合应用结核分枝杆菌DNA PCR和IGRAs可以显著增加鉴别诊断的准确性,对于早期抗结核药物的选择具有重要的指导意义.

英文摘要：

Objective To evaluate the value of interferon gamma release assays for the differential diagnosis between pulmonary tuberculosis and lung disease of non tuberculous mycobacteria （NTM）.Methods We chose 334 cases of pulmonary disease admitted in the Third People＇s Hospital of Shenzhen during the period from February 2011 to May 2013.Three hundred and thirty four sputum specimens from these patients were identified by PCR-reverse dot blot hybridization assay.An in-house ELISPOT assay was used to determine Mycobacterium tuberculosis antigen specific IFN-γ production in patients; PCR-fluorescent probe was used to detect Mycobacterium tuberculosis DNA in sputum specimens （fluorescent quantitative PCR）.Results Of 334 cases,240 cases were identified as Mycobacterium tuberculosis infection and 94 were identified as non-tuberculosis mycobacteria infection.The positive rate of fluorescent quantitative PCR and IGRAs were 74.58％ （179/240）and 77.08％ （185/240）,respectively in patients with PTB,while 10.64％（10/94） and 20.21％（19/94）,respectively in patients with lung disease of non-tuberculosis mycobacteria.The sensitivity of the fluorescent quantitative PCR and IGRAs were 74.58％ （179/240）and 77.08％（185/240）,respectively; while the specificity of the two methods were 89.36％ （84/94）and 79.79％ （75/94）,respectively.The sensitivity and specificity of two methods combined were 93.75％（225/240）and 77.66％ （73/94）,respectively.Conclusion IGRAs can detect rapidly and differentiate pulmonary tuberculosis from lung disease of non-tuberculosis mycobacteria,and the accuracy of differential diagnosis can be improved significantly when IGRAs combined with PCR,which is important to select antituberculosis drugs for patients.