ESAT-6诱导的外周血单个核细胞γ-干扰素反应对结核性脑膜炎的诊断价值  

The diagnostic value of IFN -γreaction of peripheral blood mononuclear cells induced by ESAT -6 in tuberculous meningitis

作　　者：程言博[1,2] 周延龙[2] 董艳 李新华 葛巍[2] 汪莉萍[3] 董瑞国[2] 

机构地区：[1]新疆维吾尔自治区伊犁哈萨克自治州奎屯医院神经内科,新疆奎屯833200 [2]徐州医学院附属医院神经内科,江苏徐州221002 [3]徐州医学院附属医院感染性疾病科

出　　处：《徐州医学院学报》2012年第7期448-450,共3页Acta Academiae Medicinae Xuzhou

基　　金：新疆伊犁州奎屯市科技计划项目（2011-35）

摘　　要：目的探讨6-kDa早期分泌靶抗原（ESAT-6）刺激的外周血单个核细胞（PBMC）γ-干扰素（IFN-γ）反应对结核性脑膜炎的诊断价值。方法研究对象共82例，其中结核性脑膜炎组20例，病毒性脑膜炎组25例，一般细菌性脑膜炎组17例，并设健康对照组20例。Ficoll法分离PBMC并培养，分别以ESAT-6、纯化结核菌素（PPD）、植物血凝素（PHA）和生理盐水处理。ELISA法测定各组上清IFN-γ浓度。结果ESAT-6处理引起结核性脑膜炎组显著的IFN-γ反应（与生理盐水处理相比P〈0．01）。PPD刺激在结核性脑膜炎组亦均引起IFN-γ升高反应（与生理盐水处理相比P〈0．01），但程度低于ESAT-6处理，差异有统计学意义（P〈0．01）。ROC曲线分析显示，ESAT-6处理曲线下面积为0．918（P〈0．01），95％C10．831～1．0；PPD处理曲线下面积为0．725（P〈0．05），95％C10．56～0．89。结论ESAT-6诱导的PBMCIFN-γ反应对结核性脑膜炎的诊断具有良好的敏感度和特异度，且具有较高的临床易行性。Objective To investigate the diagnostic value of interferon -γ （ INF -γ） reaction of peripheral blood mononuclear cells （ PBMC ） induced by 6 - kDa early secreted antigen target （ ESAT - 6 ） in tuberculous meningitis. Methods 62 cases of patients with meningitis and 20 cases of healthy control were recruited in this study. There were 20 cases of tuberculous meningitis （TBM group）, 25 cases of viral meningitis （VM group） and 17 cases of bacterial meningitis （ BM group）. PBMC was separated by Ficoll, and was cultured. Each group of PBMC was treated by EAST - 6, purfied protein derivatives tuberculin （PPD） , phytohemagglutinin （PHA） and normal saline （NS） respectively. The level of IFN -γ in culture supernatant was measured by ELISA kits. Results There were significant increase of IFN -γ in TBM group treated by ESAT - 6 （ compared to NS treatment, P 〈 0.01 ）. There were also increased reaction of IFN-γ in TBM group treated by PPD （compared to NS treatment, P 〈 0.01 ） , however, the level was lower than ESAT -6 treatment （P 〈 0.01 ）. By receiver operating characteristic （ROC） curve analysis, area under ROC curve of ESAT - 6 treatment was 0. 918 （P 〈 0.01 ）, 95% CI 0. 831 - 1.0, and PPD treatment was 0.725 （ P 〈 0.05 ）, 95% CI 0.56 - 0.89. Conclusion There are excellent sensitivity and specificity of ESAT - 6 induced IFN-γ reaction of PBMC in diagnoseof tuberculous meningitis, and it is relatively more feasible in clinical practice.

关 键 词：结核性脑膜炎 诊断 6-kDa早期分泌靶抗原 Γ-干扰素 

分 类 号：R529.3[医药卫生—内科学]