菌阳肺结核患者结核感染T细胞斑点试验表达水平及其临床影响因素分析  

Anlaysis of the level of T-SPOT. TB and the clinical influencing factors in the smear positive tuberculosis

作　　者：高卫卫[1] 张向荣[1] 杨燕[1] 张浩[1] 张侠[1] 

机构地区：[1]南京市胸科医院结核科,210029

出　　处：《国际呼吸杂志》2016年第17期1289-1293,共5页International Journal of Respiration

摘　　要：目的评估结核感染T细胞斑点试验（TBinfectionofTcellsspottest，TSPOT．TB）在菌阳肺结核患者外周血中的表达水平，并分析其临床影响因素。方法选取南京市胸科医院、连云港第四人民医院及盐城县人民医院2013年8月至2015年6月住院的菌阳肺结核患者463例，计算T-SPOT．TB的敏感率、早期分泌抗原靶6（ESAT-6）和培养滤液蛋白10（CFP-10）均值，并通过分析对LLT—SPOT．TB阳性及阴性患者的临床资料，分析临床中影响患者T-SPOT．TB表达的因素，最后剔除上述影响因素，得出患者T—SPOT．TB的敏感率及ESAT-6和CFP-10的表达水平。结果共收集患者463例，其中男239例，女224例，T-SPOT．TB在菌阳肺结核中的敏感率为83．59％（387／463），其中ESAT-6和CFP-10斑点数的表达水平分别为20．02±14．79（0～60）、21．19±19．40（0-80）。在影响因素分析中，复治及合并糖尿病会影响患者T-SPOT．TB的表达水平，剔除复治及合并糖尿病患者之后，T-SPOT．TB的敏感率为93．36％（211／226），ESAT-6和CFP-10斑点数的表达水平分别为22．31±15．62（O～60），26．64±19．74（0～80）。结论T-SPOT．TB在肺结核患者中有较高的敏感率，在临床影响因素中，复治及合并糖尿病会影响患者T-SPOT．TB的敏感率。在临床中，我们需结合患者疾病治疗状态、合并疾病等去评估该检验结果在肺结核诊断中的临床意义。当剔除上述影响因素后T-SPOT．TB的敏感率明显升高，值得在临床广泛应用。Objective To evaluate the level of pulmonary tuberculosis infection of T cells spot test （T-SPOT. TB） in the smear positive tuberculosis and analyze the clinical influencing factors. Methods 463 smear positive tuberculosis patients from Nanjing Thoracic Hospital, Lianyungang Fourth Peoplers Hospital and Yancheng County Peoplers Hospital from Aug 2013 to Jun 2015 were selected. T-SPOT. rB assay were performed on the subjects. Calculate the sensitivity of T-SPOT. TB, the mean value of ESAT- 6 and CFP-10. Comparative analysis was used to collect the clinical data of T-SPOT. TB positive and negative patients to analyze the factors influencing the expression of T-SPOT. TB in the clinical influencing factors. Then, we excluded the influences, obtain the sensitivity of T-SPOT. TB and the mean of ESAT-6 and CFP-10. Results 463 patients were collected. 239 men and 224 women, the sensitivity of T-SPOT. TB in the smear positive tuberculosis was 83.59 % （387/463）, the mean value of ESAT-6 and CFP-10 was 20.02 ± 14.79 （0-60） and 21.19 ± 19.40 （0-80） respectively. Among the clinical influencing factors, the retreatment and the patients with diabetes mellitus had influenced the level of T-SPOT. Rejected the retreatment and diabetes mellitus patients, the sensitive rate of T-SPOT. TB. increased from 83.59% to 93.36%,the mean value of ESAT-6 and CFP-10 was 22.31±15.62（0-60） and 26.64±19.74 （0-80） respectively. Conclusions T-SPOT. TB had a high sensitive rate in tuberculosis diagnosis, amongthe clinical impact factors, the retreatment and the patients with diabetes mellitus had influenced the T- SPOT. sensitive rate. In clinical working, we should combine the underlying disease （retreatment and the patients with diabetes mellitus） to assess the clinical effects of T-SPOT. TB in the diagnosis of tuberculosis clinical significance. Removed the clinical effects factors of T-SPOT TB, the sensitive rate increased significantly, is worth wide application in clinical working.

关 键 词：结核感染T细胞斑点试验 肺结核 诊断 

分 类 号：R521[医药卫生—内科学]