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目的研究γ-干扰素释放试验在诊断原发女性不孕患者潜伏性结核感染中的临床应用价值。方法前瞻性收集2013年1月至2015年3月我院收治的原发性女性不孕患者100例,根据两组患者结核菌素皮肤试验(TST)水平,将患者分为TST阳性组(n=64)和TST阴性(n=36)组。使用A.TB试剂盒,采用酶联免疫法(ELISA)进行γ-干扰素释放试验定量检测外周血γ-干扰素含量。比较两组患者治疗前及TST阳性组抗结核治疗后血γ-干扰素水平。结果两组患者的年龄和月经周期异常、月经量异常、白带异常、外阴瘙痒、子宫内膜形态异常率及生殖系统感染史、卡介苗接种史等差异均无统计学意义(P均>0.05)。与TST阴性组相比,TST阳性组患者血γ-干扰素水平显著增高[(8.63±3.22)IU/ml vs(3.96±1.19)IU/ml,P<0.01]。对TST阳性组64例患者给予异烟肼联合利福平治疗3个月后,其中59.38%(38例)转为阴性,根据患者TST结果分为TST阴转亚组(n=38)和TST持续阳性亚组(n=26)。TST持续阳性亚组患者血γ-干扰素水平治疗后较治疗前[(4.38±1.55)IU/ml vs(8.63±3.22)IU/ml]明显降低(P<0.01),但TST阴转亚组和TST持续阳性亚组治疗后组间比较无统计学差异[(4.30±1.09)IU/ml vs(4.38±1.55)IU/ml,P>0.05]。TST阴转亚组患者中,3例治疗后6个月成功怀孕。结论γ-干扰素释放试验在诊断原发女性不孕患者潜伏性结核感染中具有重要的临床价值。
Objective To study the clinical value of IFN-γ release in the diagnosis of latent tuberculosis infection in primary female infertility. Methods 100 cases of primary female infertility admitted to our hospital from January 2013 to March 2015 were prospectively collected. According to the level of tuberculin skin test (TST), patients were divided into TST positive group (n = 64) and TST negative (n = 36) groups. Using the A.TB kit, the IFN-γ release assay was performed by enzyme-linked immunosorbent assay (ELISA) for quantitative detection of interferon-γ in peripheral blood. The levels of interferon-γ in the two groups before and after TST-positive treatment were compared. Results There were no significant differences in age and menstrual cycle, abnormal menstruation, abnormal vaginal discharge, pruritus vulvae, abnormal endometrial morphology, reproductive system infection history and BCG vaccination history between the two groups (all P> 0.05). Compared with TST-negative group, the serum levels of interferon-γ in patients with TST-positive group were significantly increased [(8.63 ± 3.22) IU / ml vs (3.96 ± 1.19) IU / ml, P <0.01]. Sixty-three patients in TST-positive group were treated with isoniazid plus rifampicin for 3 months, 59.38% (38 cases) turned negative, and divided into TST negative subgroup (n = 38) and TST Persistent positive subgroup (n = 26). The serum levels of IFN-γ in patients with persistent positive subgroup of TST were significantly lower than those before treatment [(4.38 ± 1.55) IU / ml vs (8.63 ± 3.22) IU / ml] (P <0.01) (4.30 ± 1.09) IU / ml vs (4.38 ± 1.55) IU / ml, P> 0.05] .There was no significant difference between the two groups after treatment. TST negative subgroup of patients, 3 patients 6 months after treatment of successful pregnancy. Conclusion IFN-γ release test has important clinical value in the diagnosis of latent tuberculosis infection in primary female infertility patients.