结核感染T细胞斑点试验在结核性胸膜炎诊断中的价值  

The application value of T-SPOT. TB in the diagnosis of tuberculous pleurisy

作　　者：陈希[1] 李晓辕[2] 李玲[1] 孟萍[1] 张廷军[1] 赵红梅[1] 李云鹏[1] 

机构地区：[1]沈阳市胸科医院结核科,110044 [2]吉林大学第一医院呼吸科

出　　处：《中国防痨杂志》2015年第1期40-46,共7页Chinese Journal of Antituberculosis

摘　　要：目的评价结核感染T细胞斑点试验（T-SPOT．TB）在结核性胸膜炎诊断及鉴别诊断中的临床应用价值。方法选取沈阳市胸科医院2012年8月至2013年6月住院的诊断明确的所有胸腔积液患者93例。其中符合《临床诊疗指南结核病分册》对结核性胸膜炎诊断标准的48例患者为结核病组；根据病理学、病原学、疗效等确诊的非结核性胸腔积液45例患者为对照组。用T-SPOT．TB方法检测两组患者的外周血单个核细胞（PBMC）中对结核分枝杆菌早期分泌靶抗原6（ESAT-6）和（或）培养滤液蛋白10（CFP-10）致敏的T淋巴细胞（即斑点形成细胞，SFC）的数量，再对两组患者SFC阳性率进行比较；同时检测两组患者胸腔积液中腺苷脱氨酶（ADA）、血清结核抗体（TB-AB）、胸腔积液结核分枝杆菌培养（Mtb culture）情况，并与T-SPOT．TB检测进行比较。采用SPSS17．0统计软件进行统计学分析，各组样本“率”的比较采用Pearson χ^2检验，P〈0．05为差异有统计学意义。结果T-SPOT．TB检测在结核病组阳性率为91．67％（44／48），显著高于对照组的阳性率8．89％（4／45），差异有统计学意义（χ^2=63．73，P〈0．05）。T-SPOT．TB（E／C）的敏感度（91．67％，44／48）高于单用ESAT-6的敏感度（85．42％，41／48）或单用CFP-10的敏感度（75．00％，36／48），但差异无统计学意义（与ESAT-6比较：χ^2=0．92，P〉0．05；与CFP-10比较：χ^2=4．8，P〉0．05）。T-SPOT．TB、胸腔积液中ADA检测、血清TB-AB检测、胸腔积液Mtb culture的敏感度分别为9L67％（44／48）、70．83％（84／48）、62．50％（80／48）、14．58％（7／48）；特异度分别为91．11％（41／45）、55．56％（25／45）、62．22％（28／45）、100．00％（45／45）；诊断准确率分别为94．62％（88／93）、63．44％（59／93）、62．37％（58／98）、55．91％（52／93）；除胸腔积�Objective To evaluate the clinical application value of Mycobacterium tuberculosis T cell enzyme- linked immunospot tuberculous test （T-SPOT. TB test） in the diagnosis and differential diagnosis of tuberculous pleurisy. Methods Ninety-three patients with pleural effusion who were hospitalized in Shenyang Chest Hospital from August 2012 to June 2013 were enrolled in this study. According to the diagnostic criteria of tuberculous pleurisy in clinical guidelines for the diagnosis and treatment of tuberculosis, 48 patients with tuberculous pleurisy and 45 cases of non-tuberculous pleurisy were divided into study group and control group. The number of T lymphocytes （namely spots forming cells, SFC） to early secretary antigenic target 6 （ESAT-6 and/or culture filtrate protein （CFP-10） sensitive in peripheral blood mononuclear cell （PBMC） of participants were determined by T SPOT. TB test. The positive rates of SFC in two groups were compared. The results were compared with other related indicators （adenosine deaminase （ADA）, serum tuberculosis antibody （TB-AB）, and tuberculosis bacterium culture （Mtb culture） of pleural effusion. SPSS 17.0 was used for statistical analysis. Pearson Chi-square test was used to com- pare rates and P value less than 0.05 was considered statistically significant. Results The positive rate of tuberculous pleurisy group （91.67%, 44/48） by T SPOT. TB test was significantly higher than that of control group （8.89%, 4/45）. The difference was statistically significant （χ^2 = 63.73, P〈0.05）. The sensitivity of T-SPOT. TB test in detection of ESAT 6 and CFP-10 （91.67%, 44/48） was higher than that in detection of ESAT-6 （85.42%, 41/48） or CFP10 （75.00%, 36/48）. The difference had no statistical significance （compared with ESAT-6, χ^2 = 0.92, P〉0.05; compared with CFP-10, χ^2=4.8, P〉0.05）. The sensitivities of T-SPOT. TB, ADA detection, TB-AB detection and Mtb culture were 91.67% （44/48）, 70.83%（34/48）, 62.50% （30/48） a

关 键 词：结核 胸膜 干扰素γ释放试验 敏感性与特异性 

分 类 号：R737.9[医药卫生—肿瘤]