结核分枝杆菌感染T细胞斑点试验对淋巴结结核的辅助诊断价值研究  

Adjunctive diagnostic value of interferon-gamma release assay in tuberculosis lymphadenitis

作　　者：贾红彦[1] 潘丽萍[1] 刘菲[1] 杜博平 孙琦[1] 邢爱英[1] 杜凤娇[1] 马玙[1] 张宗德[1] 

机构地区：[1]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所耐药结核病研究北京市重点实验室,101149

出　　处：《中国防痨杂志》2014年第6期467-471,共5页Chinese Journal of Antituberculosis

基　　金：“十二五”国家科技重大专项（2012ZX10003002-003）;北京市优秀人才培养资助项目（2013D003034000038）

摘　　要：目的 探讨评价结核分枝杆菌感染T细胞斑点试验（T-SPOT.TB）对淋巴结结核的辅助诊断价值.方法 本研究募集北京胸科医院2011年7月至2013年12月收治住院的淋巴结肿大患者185例,最终分为确诊结核性淋巴结组（51例）、非结核性淋巴结疾病组（105例）,其余诊断不明确或临床诊断淋巴结结核患者予以剔除.所有患者均行外周血T-SPOT.TB及免疫印迹法检测结核分枝杆菌抗体.采用SPSS 17.0进行统计学分析,非正态分布的计量资料数据用中位数（上下四分位数）[M（P25,P75）]表示,两组间斑点形成个数（SFCs）数据比较采用Mann WhitneyU检验,组间样本率的比较采用x2检验,以P＜0.05为差异具有统计学意义.结果 T-SPOT.TB和免疫印迹法检测结核分枝杆菌抗体的敏感度分别为92.2％（47/51）和60.8％（31/51）,特异度分别为79.0％（83/105）和77.1％（81/105）,T-SPOT.TB敏感度显著高于免疫印迹法检测结核分枝杆菌抗体方法,差异有统计学意义（x2=13.95,P＜0.01）.结核分枝杆菌特异抗原刺激下结核性淋巴结组SFCs中位数为242个（57,621个）/106外周血单个核细胞（PBMCs）,非结核性淋巴结疾病组SFCs中位数为0个（0,20个）/106 PBMCs,结核性淋巴结组SFCs数量显著高于非结核性淋巴结疾病组,应用Mann Whitney U检验,两组间差异具有统计学意义（U=472.0,P＜0.01）.在T-SPOT.TB结果阳性的69例患者中,47例结核性淋巴结患者SFCs的M（P25,P75）为280个（98,684个）/106 PBMCs,显著高于对照组22例非结核性淋巴结疾病患者SFCs的M（P25,P75）52个（35,93个）/106 PBMCs（U=146.5,P＜0.01）.结论 T-SPOT.TB方法在淋巴结结核的诊断中有着较高的敏感度,有可能成为淋巴结结核辅助诊断的一项重要手段.Objective To evaluate the value of interferon-gamma release assay （T SPOT.TB） in the diagnosis of tuberculosis lymphadenitis.Methods From July 2011 to Dec 2013,185 patients with enlarged lymph node were enrolled and categorized as histopathology-confirmed tuberculosis lymphadenitis group （n=51） and no-tuberculosis lymphadenitis group （n=105）.The remaining inconclusive patients were excluded from final analysis.T-SPOT.TB with peripheral blood and tuberculosis antibody with serum by using western blot method were detectedin all patients.Statistical analysis was performed using SPSS 17.0.The measurement data of non normal distribution were expressed with the median.Spot forming cells（SFCs） were compared in different groups using nonparametric Mann Whitney U test.Comparisons between proportions were performed using Chi-squared test.Results The sensitivity and specificity of T-SPOT.TB assay were 92.2％ （47/51） and 79.0％ （83/105） respectively,however,they were 60.8％ （31/51） and 77.1 ％ （81/105） in tuberculosis antibody,respectively.The sensitivity of T-SPOT.TB assay was significantly higher than that of tuberculosis antibody with statistically significant （x2=13.95,P＜0.01）.Also,SFCs median of tuberculosis lymphadenitis group and non-tuberculosis lymphadenitis group were 242（57,621）/106 PBMCs and 0（0,20） /106 PBMCs,respectively.SFCs was significantly higher in the tuberculosis lymphadenitis group than that in non tuberculosis lymphadenitis group （U =472.0,P＜0.01）.In the 69 patients with positive T-SPOT.TB results,SFCs median with 280（98,684）/106 PBMCs in the 47 patients with tuberculosis lymphadenitis was significantly higher than 52 （35,93）/106 PBMCs in the 22 patients with non-tuberculosis lymphadenitis （U =146.5,P＜0.01）.Conclusion The T-SPOT.TB assay is high sensitivity in the diagnosis of tuberculosis lymphadenitis.It could be a useful adjunctive tool for diagnosis of tuberculosis lymphadenitis.

关 键 词：结核 淋巴结/诊断 Γ干扰素释放试验 敏感性与特异性 

分 类 号：R52[医药卫生—内科学]