T-SPOT.TB技术在潜伏结核感染者免疫抑制剂治疗中的临床应用  

T-SPOT.TB clinical value in latent tuberculosis infection by immunosuppressive therapy

作　　者：毕艳[1] 伊正君[1] 付玉荣[1] 

机构地区：[1]潍坊医学院/山东省临床检验诊断学高校重点实验室,山东潍坊261031

出　　处：《重庆医学》2015年第28期3928-3929,3932,共3页Chongqing medicine

基　　金：国家自然科学基金资助项目(81100006);山东省自然科学基金资助项目(ZR2010HM073)

摘　　要：目的探讨T-SPOT.TB技术在潜伏结核感染(LTBI)者免疫抑制剂治疗中的筛查效果,为预防和控制LTBI提供新的依据。方法应用T-SPOT.TB试剂盒对162例需要应用免疫抑制的患者进行结核分枝杆菌特异性T细胞的检测;同时对所有病例做结核菌素皮肤试验(TST);对其中28例T-SPOT.TB技术筛查阳性患者应用抗TNF-α生物制剂治疗前均给予预防性抗结核药物治疗4个月并随访1年。结果 T-SPOT.TB阳性率为36.4%,确诊率为94.9%;TST阳性率为28.4%,确诊率为69.6%。T-SPOT.TB阳性率和确诊率与TST相比,差异有统计学意义(P<0.05);通过对28例T-SPOT.TB技术筛查阳性,给予预防性抗结核药物治疗4个月的患者1年的随访,结果无一例结核病发生。结论 T-SPOT.TB技术在检测LTBI敏感性强、特异性高,是快速诊断结核感染的有效手段;在应用免疫抑制剂对LTBI的筛查诊断中具有重要临床价值。Objective To explore the T-SPOT.TB technology in latent tuberculosis infection（LTBI）who immunosuppressive therapy results in screening for latent tuberculosis infection prevention and control to provide a new basis.Methods Application of T-SPOT.TB kit 162 immunosuppressed patients need to be applied to detect M.tuberculosis-specific T cells;while doing all cases tuberculin（TST）skin test;of which 28 cases of T-SPOT.TB-positive patients before screening technique using anti-TNF-αbiologics were given prophylactic treatment of anti-TB drugs for 4months and followed a year.Results The positive rates and accuracy rate of T-SPOT.TB assay were 36.4% and 94.9%,while the positive rates and accuracy rate of TSTs were 28.4% and69.6%.The difference between T-SPOT.TB assay and TST were statistical significance（P〈0.05）.Through our 28 cases of TSPOT.TB positive screening technology,prophylactic anti-TB drugs to treat patients for 4months and 1year of follow-up,no case of tuberculosis occurred.Conclusion These results demonstrate that the performance of T-SPOT.TB is better than the classic TST for detection of LTBI in patients receiving immunosuppressive therapy for treatment of systemic autoimmune disorders.The TSPOT.TB assay will be a useful tool in early and rapid diagnosis of latent tuberculosis infection.T-SPOT.TB for LTBI patients diagnosed with prophylactic anti-TB drug treatment is necessary,has important clinical significance.

关 键 词：结核 病毒潜伏期 T-SPOT.TB 结核菌素皮肤试验 免疫抑制剂 

分 类 号：R52[医药卫生—内科学] R446.6[医药卫生—临床医学]