结核感染T细胞斑点试验检测胸腔积液和外周血对结核性胸膜炎的诊断价值  

Diagnostic value of T-SPOT.TB assay performance of pleural effusion and peripheral blood for tuberculous pleurisy

作　　者：盖林林 管立学[2] 李海波[2] 褚锦锦 张丽丽[2] 谭薇[3] 王乐强[3] 

机构地区：[1]潍坊医学院临床检验诊断学山东省"十二五"高校重点实验室,山东潍坊261053 [2]山东省潍坊市人民医院中心实验室,山东潍坊261041 [3]山东省潍坊市人民医院呼吸内科,山东潍坊261041

出　　处：《中国医药导报》2016年第22期125-128,共4页China Medical Herald

基　　金：山东省潍坊市科技发展计划项目(卫生部分)(2015WS005)

摘　　要：目的评价结核感染T细胞斑点试验（T—SPOT．TB）检测胸腔积液和外周血对结核性胸膜炎（TBP）的诊断价值。方法前瞻性纳入2013年6月～2015年8月潍坊市人民医院疑诊为结核性胸腔积液患者84例．分离患者胸腔积液单个核细胞（PEMCs）及外周血单个核细胞（PBMCs）进行T—SPOT．TB检测。比较两种标本MTB特异性抗原ESAT-6和CFP-10刺激后斑点形成细胞（SFCs）数量及其诊断特性，SFCs数量均值采用中位数（M）或四分位数间距（P25，P75）表示。结果根据临床诊断和分组标准，最终诊断TBP患者48例，非结核性胸膜炎（NTBP）患者36例；PBMCs和PEMCs T—SPOT．TB检测诊断TBP的灵敏度为81．3％和97．9％（P〈0．05），特异性为88．9％和80．6％（P〉0．05），阳性预测值为90．7％和87．0％（P〉0．05），阴性预测值为78．1％和97．6％（P〈0．05）。TBP患者PEMCs标本中ESAT6和CFP10的SFCs分别为1350（103．3，2750．0）、757．5（51．3，2512．5），PBMCs中分别为49．0（5．0，420．0）、39．5（4．3，390．5），PEMCs标本中形成的斑点数量显著高于PBMCs标本（4～15倍）（Z=4．7，P〈0．05；Z=4．3，P〈0．05）。结论PEMCsT—SPOT．TB检测对诊断TBP的灵敏度和阴性预测值高于PBMCs，但特异性和阳性预测值低于PBMCs，PEMCs和PBMCs同步检测临床诊断价值更大。Objective To investigate the diagnostic accuracy of T-cell enzyme-linked immunospot assay （T-SPOT.TB） on pleural effusion and peripheral blood for patients with tuberculous pleurisy （TBP）. Methods A total of 84 patients with clinically suspected TBP admitted from June 2013 to August 2015 in Weifang People＇s Hospital were enrolled in this prospective cohort study and examined with T-SPOT.TB on pleural effusion mononuclear cells （PEMCs） and peripheral blood mononuclear specific T cell sensitization nucleus cells （PBMCs） simultaneously. Cell numbers of spot forming cells （SFCs） formed after stimulated by MTB specific antigen ESAT-6 and CFP-10 in the two specimens and its diagnostic features were compared, average number of SFCs was expressed by median （M） and interquartile range （P25, P75）. Results According to the standard of diagnosis of TBP and grouping, 48 patients were diagnosed with TBP, and 36 cases of the non-TBP （NTBP）. The sensitivities of T-SPOT.TB on PBMCs and PEMCs for the diagnosis of TBP were 81.3% and 97.9%, respectively （P 〈 0.05）, and the positive prediction values were 90.7% and 87.0 % （P 〉 0.05）. The specificities of T-SPOT.TB on PBMCs and PEMCs for the identification of NTBP were 88.9% and 80.6%, respectively （P 〉 0.05）, and the negative prediction values were 78.1% and 97.6% （P 〈 0.05）. Numbers of SFCs of the early secretory antigenic target 6 （ESAT-6） and CFP-10 in samples of patients with TBP were 1350 （103.3, 2750.0）, 757.5 （51.3, 2512.5） on PEMCs and 49.0 （5.0, 420.0）, 39.5 （4.3, 390.5） on PBMCs respectively, numbers of SFCs of the ESAT-6 and CFP-10 on PEMCs samples of patients with TBP were significantly higher （4-15 times） than that on PBMCs samples （Z = 4.7, P 〈 0.05; Z = 4.3, P 〈 0.05）, Conclusion PEMCs T-SPOT.TB assay has highly sensitivity and negative prediction value for diagnosis of TBP, but PBMCs T-SPOT.TB has highly specificity and positive prediction value. Both PEMCs and PBMCs T-SPOT.TB as

关 键 词：结核性胸膜炎 结核感染T细胞斑点试验 胸腔积液 外周血 诊断价值 

分 类 号：R521[医药卫生—内科学]