结核感染T细胞斑点实验在结缔组织病患者中辅助诊断结核感染的应用  

Application of T-SPOT. TB in connective tissue disease combined with tuberculosis

作　　者：钟一鸣[1] 谷秀梅[1] 刘文恩[1] 李艳明[1] 金燕[1] 彭婉婵[1] 

机构地区：[1]中南大学湘雅医院检验科,长沙410008

出　　处：《中华检验医学杂志》2014年第2期132-135,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨结核感染T细胞斑点实验（T—SPOT．TB）T—SPOT．TB对结缔组织病（CTD）合并结核感染的辅助诊断价值。方法病例对照研究。选取2011年9月至2012年7月中南大学湘雅医院风湿免疫科收治的CTD合并结核感染患者44例，并随机选取同期未有结核感染的CTD患者44例作为对照，比较结核感染T细胞斑点实验（T—SPOT．TB）和结核菌素皮肤试验（TST）对CTD合并结核感染患者的辅助诊断价值，评价两组T．SPOT．TB结果斑点形成细胞频数，分析导致T．SPOT．TB假阴性的相关危险因素，采用t检验罚。检验及受试者操作特征（ROC）曲线进行统计学分析。结果T—SPOT．TB诊断CTD合并结核感染的敏感度为70．5％（31／44），显著高于TST（27．3％，12／44，，=16．42，P〈0．001），两项指标的特异度分别为93．2％（4l／44）和88．6％（39／44），差异无统计学意义（x2=0．14，P：0．711），T—SPOT．TB诊断CTD合并结核感染的阳性预测值为91．2％（31／34），阴性预测值为75．9％（41／54），约登指数为0．64，阳性似然比为10．3，均高于TST（0．16和2．4），而其阴性似然比为0．32，低于TST（0．82）。当T—SPOT-TB斑点形成细胞频数取值为38个斑点形成细胞（SFC）／10。外周血单个核细胞时，诊断结核感染有最佳截断值。对T—SPOT-TB诊断假阴性分别进行相关危险因素分析，发现年龄、激素或免疫抑制剂的使用、淋巴细胞减少症和低白蛋白血症均不是T—SPOT-TB诊断假阴性的危险因素。结论T—SPOT．TB对CTD合并结核感染的辅助诊断价值明显高于TST。（中华检验医学杂志．2014。37：132-135）Objective To investigate the diagnostic value of the T-SPOT. TB in connective tissue disease（CTD） combined with tuberculosis. Methods This is a case-control study. Forty-four patients with CTD combined with tuberculosis were enrolled from Xiangya Hospital of Central South University from September 2011 to July 2012. Another forty-four CTD patients without tuberculosis were evaluated as a control group. The diagnostic value of T-SPOT. TB and risk factors of the false negative results by T-SPOT. TB were analyzed. Results The sensitivity of T-SPOT. TB （70. 5% ,31/44） was significantly higher than that of TST（27.3% ,12/44） for CTD combined with tuberculosis patients （X2 = 16.42, P 〈 0. 001 ）. The specificity of T-SPOT. TB and TST were 93.2% （41/44） and 88.6% （39/44） ,respectively. There was no significant difference between the specificity （X2 =0. 14, P = 0.711 ）. The positive predictive value of T-SPOT. TB was 91.2% （31/34 ）. The negative predictive value was 75.9% （41/54 ）. Youden＇s index was 0. 64, and the positive likelihood ratio was 10.3. All the index were higher than that of TST （0. 16 and 2. 4）. While the negative likelihood ratio which was 0. 32 was lower than that of TST （ 0. 82 ）. When spot forming cell frequencies of T-SPOT. TB of PBMC was set to 38SFCs/106 PBMC, it had the best cut-off value. Age, use of glucocorticoids or immunosuppressant therapy, lymphocytopenia and hypoalbuminemia were not associated with false negative T-SPOT. TB assay. Conclusion The T-SPOT. TB assay is much more useful than TST for diagnosing CTD combined with tuberculosis. （Chin J Lab Med,2014,37：132-135）

关 键 词：结缔组织疾病 结核 1干扰素释放试验 结核菌素试验 试验预期值 危险因素 

分 类 号：R593.2[医药卫生—内科学] R446.6[医药卫生—临床医学]