ELISPOT检测胸水γ干扰素效应T细胞对结核性胸膜炎的诊断价值研究  

A study of the value of an ELISPOT assay of pleural fluid in diagnosing tuberculous pleuritis

作　　者：白雪娟[1] 梁艳[1] 刘银萍[1] 阳幼荣[1] 刘宇[1] 崔磊[1] 王瞳[1] 李江英[1] 吴雪琼[1] 

机构地区：[1]解放军第309医院全军结核病研究所,全军结核病防治重点实验室/结核病诊疗新技术北京市重点实验室,北京100091

出　　处：《中国病原生物学杂志》2015年第4期299-302,共4页Journal of Pathogen Biology

基　　金：“十二五”国家重大传染病科技专项(No.2013ZX10003003-005);军队医学科技“十二五”重点项目(No.BWS11J050)

摘　　要：目的研究酶联免疫斑点试验(ELISPOT)检测胸水γ干扰素效应T细胞对结核性胸膜炎的诊断价值。方法收集解放军第三O九医院临床确诊的120例结核性胸膜炎患者和55例其他原因所致胸膜炎患者(如恶性或炎性反应等)治疗前的胸水单个核细胞(PEMCs)及外周血单个核细胞(PBMCs),用重组CFP10-ESAT6融合蛋白刺激后应用ELISPOT法检测分泌γ干扰素的效应T细胞斑点形成细胞数(SFCs)。结果结核性胸膜炎组(结核组)PBMCs及PEMCs产生的SFCs值均显著高于非结核性胸膜炎组(非结核组)(P<0.01),结核组PBMCs与PEMCs产生的SFCs值差异无统计学意义(P>0.05),但非结核组PBMCs产生的SFCs值显著高于PEMCs(P<0.05)。结核组血和胸水性胸膜炎ELISPOT阳性率分别为62.9%和60.8%,与非结核组36.6%和16.4%比较差异有统计学意义(P<0.05)。结核组血和胸水ELISPOT阳性率比较差异无统计学意义(P>0.05),但非结核组血ELISPOT阳性率显著高于胸水(P<0.05)。依据PEMC ELISPOT结果诊断结核的灵敏度为60%(63/105),特异度为82.9%(34/41),优于PBMCs和PEMC+PBMCs ELISPOT。结论胸水ELISPOT检测是一种较灵敏、特异的结核性胸膜炎辅助诊断和鉴别诊断方法。Objective To study the value of an enzyme-linked immunospot （ELISPOT） assay of pleural fluid in diagnosing tuberculous pleurisy. Methods Subjects were 120 patients with tuberculous pleurisy （the TB group） and 55 patients with non tuberculous pleurisy （malignant pleurisy or an inflammatory reaction, the non-TB group） from the 309th Hospital of the Chinese PLA. Mononuclear cells and lymphocytes from pleural fluid and peripheral blood （pleural fluid mononuclear cells or PFMCs and peripheral blood mononuclear cells or PBMCs） were separated and collected before treat- ment. T cells that secreted INF- in response to a recombinant CFP10-ESAT6 fusion protein were detected as spot-forming cells （SFCs） in an ELISPOT assay. Results The TB group had significantly more SFCs （PBMCs and PFMCs） than did the non-TB group （P〈0.01）. There was no statistical difference in th SFCs among PBMCs and PFMCs （P〉0.05） in the TB group. The non-TB group were significantly more SFCs among PBMCs than among PFMCs （P〈 0. 05）. An ELISPOT assay of peripheral blood from the TB group tested positive for myeobacteria at a rate of 62.9 % and an ELlS- POT assay of pleural fluid from that group tested positive for mycobacteria at a rate of 60.8% ; these rates were significantly higher than those in the non-TB group （36.6% and 16.4%, P〈0.05）. There were no significant differences between the rates at which the ELISPOT assay of peripheral blood and the ELISPOT assay of pleural fluid tested positive for myeobacteria （P〉0. 05） in the TB group, but the ELISPOT assay of peripheral blood from the non-TB group tested positive for mycobacteria at a significantly higher rate that did the ELISPOT assay of pleural fluid from that group （P〈0. 05）. The ELISPOT assay of pleural fluid had a sensitivity of 60% and a specificity of 82.9% at diagnosing mycobacterial infection, and this performance was better than that of an ELISPOT assay of peripheral blood alone or an ELISPOT assay of peripheral blood and pleural

关 键 词：结核 胸膜炎 胸水 酶联免疫斑点实验 诊断 

分 类 号：R521.7[医药卫生—内科学]