T细胞斑点检测在鉴别结核分枝杆菌与非结核分枝杆菌感染中的价值  

The value of T-SPOT for the differential diagnosis between tuberculosis and non-tuberculosis mycobacteria

作　　者：沈彦恒[1] 桂徐蔚[1] 沈芸[1] 沙巍[1] 

机构地区：[1]同济大学附属上海市肺科医院结核病临床研究中心,上海市结核病重点实验室,上海200433

出　　处：《中国医刊》2016年第4期78-81,共4页Chinese Journal of Medicine

摘　　要：目的评价T细胞斑点检测(T cell spot test,T-SPOT)在鉴别结核分枝杆菌(mycobacterium tuberculosis,Mtb)与非结核分枝杆菌(nontuberculous mycobacteria,NTM)感染中的价值。方法选择本院2013年1月至2015年7月间住院并确诊为分枝杆菌感染的177例患者,在这177例患者中,有106例患者明确为结核分枝杆菌感染,其中82例为痰培养明确(其中有1例胸水同时培养明确),17例为灌洗液培养明确,3例胸水培养明确,1例心包积液培养明确,1例皮肤脓液培养明确,3例脑脊液培养明确;另71例患者则为本院或外院痰或支气管肺泡灌洗液培养明确为NTM感染。对所有研究对象外周血进行T-SPOT检测,分析检测结果。结果 Mtb患者的T-SPOT检测阳性率为96.23%(102/106);而NTM患者的T-SPOT检测阳性率为39.44%(28/71),T-SPOT检测鉴别Mtb与NTM感染的灵敏度为96.23%(102/106),特异度为60.56%(43/71),差异具有显著性(P<0.05)。结论 T-SPOT作为一种新的诊断技术,在鉴别诊断Mtb与NTM感染方面具有极高的灵敏度和较好的特异度,在临床诊断中具有较好的应用价值。Objective To evaluate the value of T-SPOT for the differential diagnosis between tuberculosis and disease of non-tuberculosis mycobacteria. Method During January 2013 to July 2015,106 patients with culture-confirmed mycobacterium tuberculosis and 71 patients with culture-confirmed nontuberculous mycobacteria（NTM） were enrolled from Shanghai Pulmonary Hospital. For 106 tuberculosis cases, 82 cases were sputum culture positive 1 of which was both hydrothrax culture positive, 17 cases were bronchoalveolar lavage fluid culture positive, 1 case was hydrothorax culture positive, 1 case was hydropericardium culture positive, 1 case was shin fester culture positive, 3 cases were cerebrospinal fluid culture positive, and 71 were identified as non-tuberculosis mycobacteria infection with sputum culture positive or bronchoalveolar lavage fluid culture positive.Peripheral blood T-SPOT was proformed in the subjects, and the results were analyzed. Result The positive rate of T-SPOT were 96.23%（102/106） in mycobacterium tuberculosis infection cases and 39.44%（28/71） in nontuberculosis mycobacteria infection caeses, respectively, while the sensitivity and specificity of T-SPOT were 96.23%（102/106） and 60.56%（43/71）, respectively. Conclusion T-SPOT, as a new diagnostic technique, has superior diagnostic sensitivity and specificity in the differential diagnosis of mycobacterium tuberculosis and mycobacterium tuberculosis infection, which has certain value in clinical application.

关 键 词：T细胞斑点检测 分枝杆菌感染 结核分枝杆菌 非结核分枝杆菌 诊断 

分 类 号：R52[医药卫生—内科学]