酶联免疫斑点技术对小儿结核病的诊断价值  

Diagnostic Value of Enzyme-Linked Immunospot Assay for Tuberculosis in Children

作　　者：张卫平[1] 韩文[2] 董菊[1] 多力坤[1] 罗琼[1] 

机构地区：[1]新疆医科大学第一附属医院儿科,乌鲁木齐830054 [2]新疆克拉玛依市中心医院儿科,新疆维吾尔自治区克拉玛依834000

出　　处：《实用儿科临床杂志》2009年第4期277-279,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨酶联免疫斑点技术(ELISPOT)对新疆地区小儿结核病的诊断价值。方法收集2006年10月-2007年12月新疆医科大学第一附属医院儿科2个月～14岁疑似结核病的115例患儿,采集外周静脉血,利用ELISPOT结核感染T细胞诊断试剂盒进行ELISPOT检测,同期行结核菌纯蛋白衍生物(PPD)试验,并进行全面临床评估,随访3～6个月,结合疗效进行最终诊断。对ELISPOT检测结果与最终确诊结果进行比较,计算其灵敏度、特异度,并与PPD试验作对比。分析不同年龄组(≤36个月龄及>36个月龄)、有无并营养不良、是否为重症结核病、结核部位(肺结核或肺外结核)以及不同民族(维吾尔族、汉族)间ELISPOT检测与PPD试验阳性率的差异,及不同因素对ELISPOT试验和PPD试验结果的影响。结果ELISPOT诊断小儿结核病的灵敏度80%,特异度86%。ELISPOT试验阳性率显著高于PPD试验阳性率(P<0.01)。在结核病病例中,并营养不良组及重症结核病组PPD试验阳性率明显低于未并营养不良组及非重症结核病组(Pa<0.05),而ELISPOT阳性率在各组间均无统计学差异(Pa>0.05);>36个月龄组与≤36个月龄组、维吾尔族组与汉族组、肺结核组与肺外结核组比较,无论ELISPOT试验还是PPD试验的阳性率均无统计学差异(Pa>0.05)。结论ELISPOT诊断小儿结核病敏感、快速,而且受营养不良、重症结核病因素的影响较小,对儿童结核病具有较高的诊断价值,可用于新疆地区小儿结核病的早期快速诊断。Objective To explore the diagnostic utility of enzyme - linked immunospot assay （ELISPOT） for tuberculosis in children in Xinjiang Uygur Autonomous Region. Methods From Oct. 2006 to Dec. 2007, total of 115 consecutive cases of children aged from 2 months to 14 years old who were being assessed for suspected tuberculosis were enrolled from the first affiliated hospital of Xinjiang medical university. Peripheral venous blood were collected for ELISPOT tests using T - cell ELISPOT infection diagnosis kit and purified protein derivative （PPD） test were proceeded at the same time as well as full clinical assessment. The final diagnosis were assessed through 3 -6 months follow - up. The ELISPOT results were compared with the final diagnosis to calculate its sensitivity, specificity, and were compared with the positive rate of PPD test. Between different groups （ ≤36 months or 〉 36 months, complicated with malnutrition or not, severe tuberculosis or not, palmonary tuberculosis or extrapulmonary tuberculosis, Uygurs or Han）, the positive rates of ELISPOT or PPD test were compared to analyze the impact factors to those results. Results The sensitivity and specificity of ELISPOT at diagnosed for tukerculosis was 80% ,86% ,respectively. The positive rates of ELISPOT was significantly higher than that of PPD test （ P 〈 0. 01 ）. In tuberculosis group, the positive rates of PPD test had significant difference in children with malnutrition or severe tuberculosis compared with children without malnutrition or severe tuberculosis （P 〈 0. 05 ）, while the positive rate of ELISPOT test had no significant differences between those subgroups （Pa 〉 0. 05 ）. In the subgroups of ≤36 months and 〉 36 months, Uygurs and Han, pulmonary tuberculosis and extrapulmonary tuberculosis, the positive rates of ELISPOT and PPD test had no significant differences（ Pa 〉 0. 05 ）. Conclusions ELISPOT is sensitive and fast to diagnose childhood tuberculosis and is less affected by factors such as malnutrition an

关 键 词：酶联免疫斑点技术 结核病 诊断 儿童 

分 类 号：R725.1[医药卫生—儿科]