摘要
目的探讨结核感染T细胞斑点试验(T-SPOT.TB)对肺内、肺外结核的诊断效能,分析结核细胞斑点数在结核诊断中的临床应用价值。方法应用T-SPOT.TB试验,结核菌素皮肤试验(PPD)和结核抗体检测试验(TB.AB)3种检测方法分别对78例活动性肺结核患者,58例活动性肺外结核患者,27例陈旧性肺结核患者及76例非结核疾病患者进行检测。结果 (1)T-SPOT.TB试验对结核感染诊断的敏感度为71.17%,特异度为78.95%,敏感度为3种检测方法中最高;三种试验联合检测对结核感染诊断的敏感度明显增加,约登指数最大,特异度稍降低。(2)T-SPOT.TB试验对活动性肺结核组和活动性肺外结核组检测的阳性率及细胞斑点数差异均无统计学意义(P>0.05)。TSPOT.TB试验对活动性肺结核与陈旧性肺结核检测的阳性率差异无统计学意义(P>0.05),但活动性肺结核细胞斑点数显著高于陈旧性肺结核(P<0.05)。(3)对检测阈值进行优化发现,当TSPOT.TB细胞斑点数取值为11.5个细胞斑点数(SFC)/10~6外周血单个核细胞(PBMC)时,检测结核感染效能最高;T-SPOT.TB细胞斑点数取值为17 SFC/10~6 PBMC时,是区分活动性肺结核与陈旧性肺结核的最佳阈值。结论采用T-SPOT.TB试验,PPD试验和TB.AB试验三种试验方法联合检测,可明显提高结核感染的检出率;T-SPOT.TB试验对肺内肺外结核病均具有较好的辅助诊断价值;进一步对T-SPOT.TB试验细胞斑点数检测阈值进行优化,可以更好地指导结核的早期诊断与治疗。
Objective To investigate the diagnostic value of enzyme-linked immunospot assay for tuberculosis （T-SPOT. TB） in pulmonary tuberculosis and non-pulmonary tuberculosis, and evaluate the clinical application value of T-SPOT. TB＇s spot forming cell frequencies in the diagnosis of tuberculosis. Methods T-SPOT. TB, tuberculin test （PPD） assay, and tuberculosis antibody test （TB. AB） were used in the diagnosis of tuberculosis among 78 active pulmonary tuberculosis patients, 58 active non-pulmonary tuberculosis patients, 27 old pulmonary tuberculosis patients, and 76 non-tuberculosis patients. Results （1） The sensibility and specificity if T-SPOT. TB assay were 71.17% and 78.95%, the highest among 3 methods. Three trialsg joint detection obviously increased the sensitivity of tuberculosis diagnosis. （2） The positive rate of T-SPOT. TB and spot forming cell frequencies in active pulmonary tuberculosis and active non-pulmonary tuberculosis were not statistically significant （ P 〉 O. 05 ）. The positive rate of T-SPOT. TB in active pulmonary tuberculosis and old pulmonary tuberculosis were not statistically significant （ P 〉 0.05 ）. However, spot forming cell frequencies of T-SPOT. TB in active pulmonary tuberculosis were significantly higher than old pulmonary tuberculosis （P 〈 0. 05 ）. （3） When spot forming cell frequencies of T-SPOT. TB. of peripheral blood mononuclear cell （PBMC） was set to 11.5 spots-forming cell （SFC）/106 PBMC, it had the best cut-off value to diagnose the tuberculosis as a diagnostic criteria. （4） When spot forming cell fre- quencies of T-SPOT. TB of PBMC was set to 17 SFC/106pBMC, it had the best cut-off value to distinguish the active pulmonary tuberculosis from old pulmonary tuberculosis. Conclusions The joint detection of T- SPOT. TB assay, PPD assay and TB. AB assay, could obviously improve the positive rate of TB infection. T-SPOT. TB assay has useful diagnostic value for pulmonary tuberculosis and non-pulmonary uberculosis. Rea- sonable a
出处
《中国医师杂志》
CAS
2018年第1期87-91,共5页
Journal of Chinese Physician
