结核T细胞酶联免疫斑点试验诊断结核感染的临床应用  

Clinical application of T cell enzyme-linked immunospot assay in tuberculosis patients

作　　者：陆建红[1] 陈国军[1] 杜开齐[2] 董长林[1] 杨勇[1] 金益军[1] 

机构地区：[1]武警浙江总队医院检验科,嘉兴314000 [2]武警浙江总队医院胸外科,嘉兴314000

出　　处：《武警医学》2013年第10期866-868,871,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨结核T细胞酶联免疫斑点试验(T-SPOT.TB)诊断结核感染的临床应用价值。方法选择结核分枝杆菌感染者103例及非结核病对照者30例,用酶联免疫斑点试验检测外周血单个核细胞经结核特异性蛋白6KD早期分泌靶向抗原,以及培养滤液蛋白10刺激产生γ-干扰素的T淋巴细胞数,并与血清抗结核抗体、结核菌素皮肤试验结果比较。结果 T-SPOT.TB诊断结核感染的敏感性和特异性为95.15%、93.33%;阳性预则值和阴性预测值为98.00%、84.85%;阳性似然比和阴性似然比为14.27%、0.05%,均优于血清抗结核抗体、结核菌素皮肤试验(P<0.01),但方法间一致性较弱(Kappa<0.40,P<0.001),差异有统计学意义。结论 T-SPOT.TB检测在结核分枝杆菌(MTB)感染的筛查,快速早期辅助结核病诊断和排除感染方面意义重大。Objective To investigate the diagnostic value of T cell enzyme-linked immunospot （ELISPOT） assay in tuberculosis patients. Methods 103 patients with Mycobacterium tuberculosis （MTB） infection and 30 controls with non-MTB infection were recruited to detect early secreting antigen target-6（ESAT-6） and culture filtrate protein-10（CFP-10） specific T cells in blood samples by ELISPOT assay, then compare it with serum tuberculosis antibody（TB-Ab） and PPD skin test. Results The sensitivity, specificity, positive prospective value, negative prospective value, positive likelihood ratio and negative likelihood ratio of T cell ELISPOT assay were 95.15%, 93.33%, 98.00%, 84.85 %, 14.27% , and 0.05%, respectively. All these indexes were significantly higher than those of TB-Ab and PPD skin test（P〈0.01）, meanwhile T cell ELISPOT assay had low agreement with means of TB-Ab and PPD skin test（Kappa〈0.40, P〈0.001）. Conclusions T cell ELISPOT assay has a higher sensitivity and specificity than conventional test in the diagnosis of tuberculosis; therefore,it has great value and applicability as a screening test.

关 键 词：T淋巴细胞 酶联免疫斑点试验 诊断 结核分枝杆菌 感染 

分 类 号：R446.6[医药卫生—诊断学]