儿童肺结核γ-干扰素释放试验假阴性结果影响因素分析

doi:10.12372/jcp.2025.24e0168

Abstract

Abstract:

Objective To investigate the diagnostic value of interferon-gamma release assay (IGRA) in pediatric pulmonary tuberculosis (PTB) and analyze the risk factors of negative IGRA results. Method A total of 77 children with confirmed PTB who were hospitalized in our hospital from January 2018 to June 2023 were included in the study. Based on IGRA results, they were categorized into positive and false-negative groups. The sensitivity of IGRA for diagnosing pediatric PTB was evaluated, and the factors contributing to false-negative results were analyzed. Result The sensitivity of Tuberculin skin test (TST) for diagnosing pediatric PTB was 67.53% (52/77), while that of IGRA was 77.92% (60/77). The agreement rate between TST and IGRA was 79.22%, with a Kappa value of 0.48, indicating moderate consistency. Multivariate analysis revealed that the induration reaction of TST (moderate positive OR=0.066, 95%CI:0.009-0.471, P=0.007, strong positive OR=0.023, 95%CI: 0.002-0.275, P=0.003) and albumin-to-globulin ratio (OR=17.193,95%CI: 2.379-124.247, P=0.005) were independent predictors of false-negative IGRA results. Conclusion Due to the immature development of the immune system, children should be vigilant against the possibility of false negative results of IGRA. Emphasis on molecular biological and pathological examinations is crucial for achieving an early and accurate diagnosis, thereby preventing delayed treatment and missed opportunities for optimal care.

Key words: pulmonary tuberculosis, interferon-gamma release assay, false negative, child

CLC Number:

JIANG Wenwen, LI Sitong, XU Yongsheng. Analysis on risk factors associated with false-negative results of interferon-gamma release assay in children with pulmonary tuberculosis[J].Journal of Clinical Pediatrics, 2025, 43(7): 519-524.

Figures/Tables 4

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References 20

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项目	阳性组(n=60)	阴性组(n=17)	统计量	P
性别（男/女）	28/32	8/9	0.00	0.977
年龄[M(P₂₅~P₇₅]/岁	12.04(9.04~13.83)	3.92(0.54~7.92)	3.19	0.001
<1	4(6.67)	5(29.41)	16.18	0.003
1~<3	3(5.00)	2(11.76)
3~<7	4(6.67)	3(17.65)
7~<10	7(11.67)	4(23.53)
10~<18	42(70.00)	3(17.65)
BMI[M(P₂₅~P₇₅)]/kg·m^-2	16.00(14.76~18.16)	15.42(14.27~16.82)	1.28	0.199
BCG接种史[n(%)]	58(96.67)	16(94.12)	-	0.532¹⁾
结核接触史[n(%)]	26(43.33)	4(23.53)	2.19	0.139
居住地（农村/城市）	49/11	16/1	0.76	0.384
肺外结核[n(%)]	7(11.67)	5(29.41)	1.97	0.161
下呼吸道感染[n(%)]	13(21.67)	9(52.94)	4.91	0.027
发热[n(%)]	38(63.33)	11(64.71)	0.01	0.917
咳嗽咳痰≥2周[n(%)]	51(85.00)	10(58.82)	4.04	0.044
体重减轻[n(%)]	13(21.67)	2(11.76)	0.32	0.573
胸痛[n(%)]	8(13.33)	1(5.88)	0.17	0.667
咯血或痰中带血[n(%)]	6(10.00)	1(5.88)	0.00	0.965

项目	阳性组(n=60)	阴性组(n=17)	统计量	P
TST硬结反应[n(%)]			χ²=19.27	<0.001
阴性	9(15.00)	12(70.59)
一般阳性	3(5.00)	1(5.88)
中度阳性	23(38.33)	3(17.65)
强阳性	25(41.67)	1(5.88)
HGB（$\bar{x}\pm s$）/g·L^-1	122.33±12.70	110.82±17.38	t=3.03	0.003
WBC×10⁹[M(P₂₅~P₇₅)]/L^-1	7.98(6.71~9.75)	10.07(6.83~13.51)	Z=1.84	0.066
N×10⁹[M(P₂₅~P₇₅)]/L^-1	5.02(3.67~6.75)	4.84(2.57~9.15)	Z=0.20	0.839
L×10⁹[M(P₂₅~P₇₅)]/L^-1	1.81(1.47~2.40)	2.84(1.79~4.12)	Z=2.29	0.022
M×10⁹[M(P₂₅~P₇₅)]/L^-1	0.66(0.44~0.92)	0.67(0.53~0.86)	Z=0.31	0.759
E×10⁹[M(P₂₅~P₇₅)]/L^-1	0.09(0.03~0.15)	0.11(0.03~0.28)	Z=0.82	0.410
PLT×10⁹[M(P₂₅~P₇₅)]/L^-1	364.38±86.25	363.94±166.14	t=0.01	0.992
CPR[M(P₂₅~P₇₅)]/mg·L^-1	16.50(3.10~40.65)	7.00(2.50~73.31)	Z=0.28	0.776
NLR[M(P₂₅~P₇₅)]	2.54(1.58~4.54)	1.54(0.84~4.77)	Z=1.52	0.128
LMR[M(P₂₅~P₇₅)]	3.15(1.90~4.57)	4.06(2.60~7.39)	Z=1.82	0.069
PLR[M(P₂₅~P₇₅)]	197.14(133.21~251.71)	104.42(80.07~186.90)	Z=2.49	0.013

项目	阳性组(n=60)	阴性组(n=17)	统计量	P
LDH[M(P₂₅~P₇₅)]/U·L^-1	259.00(211.25~340.00)	305.00(230.50~367.00)	Z=1.17	0.243
PCT[M(P₂₅~P₇₅)]/ng·mL^-1	0.06(0.04~0.12)	0.05(0.04~0.21)	Z=0.51	0.613
IL-6[M(P₂₅~P₇₅)]/pg·mL^-1	17.87(7.00~34.14)	23.98(1.73~50.11)	Z=0.26	0.792
ALB[M(P₂₅~P₇₅)]/g·L^-1	42.30(39.93~45.10)	40.80(36.60~44.55)	Z=1.01	0.314
GLB[M(P₂₅~P₇₅)]/g·L^-1	29.10(25.18~31.48)	23.70(17.95~27.55)	Z=3.04	0.002
A/G（$\bar{x}\pm s$）	1.49±0.34	1.85±0.62	t=2.31	0.033
IgG相对率[M(P₂₅~P₇₅)]	1.08(0.89~1.19)	1.08(0.89~1.16)	Z=0.20	0.844
IgA相对率[M(P₂₅~P₇₅)]	1.27(0.83~1.72)	1.14(0.93~1.81)	Z=0.21	0.835
IgM相对率[M(P₂₅~P₇₅)]	0.87(0.65~1.09)	0.85(0.50~1.65)	Z=0.03	0.976
IgE[M(P₂₅~P₇₅)]/IU·mL^-1	91.92(23.49~250.03)	65.14(16.03~543.60)	Z=0.18	0.854
CD3⁺相对率[M(P₂₅~P₇₅)]	0.75(0.60~1.12)	0.93(0.54~1.38)	Z=0.98	0.326
CD4⁺相对率（$\bar{x}\pm s$）	0.95±0.43	1.09±0.71	t=0.76	0.459
CD8⁺相对率[M(P₂₅~P₇₅)]	0.76(0.51~1.02)	0.91(0.54~1.38)	Z=1.05	0.294
CD4⁺/CD8⁺[M(P₂₅~P₇₅)]	1.54(1.22~1.98)	1.48(1.12~2.41)	Z=0.50	0.619

变量/指标	β	SE	χ²值	df	P	OR	95%CI
TST硬结反应			12.32	3	0.006
一般阳性	2.63	1.74	2.30	1	0.129	0.07	0.002~2.159
中度阳性	2.72	1.00	7.34	1	0.007	0.07	0.009~0.471
强阳性	3.77	1.26	8.89	1	0.003	0.02	0.002~0.275
HGB	0.05	0.03	3.49	1	0.062	0.95	0.901~1.003
A/G	2.85	1.01	7.95	1	0.005	17.19	2.379~124.247

Analysis on risk factors associated with false-negative results of interferon-gamma release assay in children with pulmonary tuberculosis

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