结核分枝杆菌效应T细胞检测在诊断活动性结核病中的价值  

Value of Mycobactrium tuberculosis-specific effector T cell assay in diagnosis of active tuberculosis

作　　者：李根[1] 李春玲[1] 李海聪[2] 赵慧敏[2] 李锋[2] 胡志东[2] 卢水华[2] 范小勇[1] 吕建新[1] 

机构地区：[1]温州医科大学检验医学院生命科学学院,325035 [2]上海市(复旦大学附属)公共卫生临床中心

出　　处：《中国防痨杂志》2017年第5期495-498,共4页Chinese Journal of Antituberculosis

基　　金：“十二五”国家科技重大专项（2013ZX10003007003）;国家自然科学基金（81273328、31170876）;上海市科学技术委员会科研计划项目（17ZR1423900、134119a5200）

摘　　要：目的分析结核分枝杆菌效应T细胞检测法在诊断活动性结核病中的价值。方法选取2015年1-12月来自上海市公共卫生临床中心、上海市肺科医院和沈阳市胸科医院的708例活动性结核病患者、289例非结核肺部疾病患者和55名健康志愿者作为研究对象。将55名健康志愿者和289例非结核肺部疾病患者作为非活动性结核组。活动性结核组包括68例肺外结核患者和640例肺结核患者，肺结核并发肺外结核者归属为肺结核患者；在肺结核患者中有230例患者痰标本的细菌学检查呈阳性，410例痰标本细菌学检查阴性。分离研究对象外周血单核细胞，应用结核分枝杆菌效应T细胞检测试剂盒进行检测，评价该检测方法的诊断效能。结果结核分枝杆菌效应T细胞检测试剂盒检测活动性结核组的敏感度为81．78％（579／708）；检测非活动性结核组的特异度为79．36％（273／344）；检测健康志愿者的特异度为89．09％（49／55）。在经检测结果为阳性的650例研究对象中，正确检出阳性579例，阳性预测值为89．08％；在所有检查结果为阴性的402例研究对象中，正确检出阴性273例，阴性预测值为67．91％（273／402）；阳性似然比、阴性似然比和正确诊断效率依次为3．96、0．23和80．99％（852／1052）。检测痰检阳性患者的阳性检出率相对更高，为84．78％（195／230）；检测肺结核并发肺外结核患者的阳性检出率为91．49％（43／47）。结论结核分枝杆菌效应T细胞检测试剂盒对于活动性结核病的诊断具有较高的敏感度和特异度，尤其在肺结核并发肺外结核的患者以及痰检阳性的肺结核患者中效果较好，可用于辅助诊断活动性结核病。Objective To evaluate the value of Mycobactrium tuberculosis-specific effector T cell assay in diag- nosis of active tuberculosis （ATB）. Methods A total of 708 ATB patients, 289 non-tuberculosis （Non-TB） pa- tients and 55 healthy controls were recruited from Shanghai Public Health Clinical Center, Shanghai Pulmonary Hospital and Shenyang Chest Hospital between January 2015 and December 2015 and were then tested by the Mycobactrium tuberculosis-specific effector T cell assay. Non-active tuberculosis （NATB） group included 55 heathy individuals and 289 Non-TB patients. And 708 ATB patients included 640 cases of pulmonary tuberculosis （PTB） and 68 cases of extra-pulmonary tuberculosis （EPTB）, in which the patients suffered from PTB complicated with EPTB were classified into PTB cases. Of the PTB cases, 230 were positive and 410 were negative in sputum smear test. The peripheral blood mononuclear cells （PBMC） were separated and then detected Mycobactriurn tuberculosis specific effector T cell assay to evaluate its value in diagnosis of ATB. Results The results showed that the sensi tivity of Mycobactrium tuberculosis-specific effector T cell assay in the ATB patients was 81.78% （579/708）; the specificity of Mycobactrium tuberculosis-specific effector T cell assay in the Non-TB patients and healthy controls were 79.36% （273/344） and 89.09% （49/55）, respectively. Among all the 650 positive cases, 579 were detected correctly and the positive predictive value was 89.08% while of the 402 negative cases, 273 were detected correctly and the negative predictive value was 67.91%. Additionally, positive likelihood ratio （LR＋）, negative likelihood

关 键 词：结核 T淋巴细胞 试剂盒 诊断 酶联免疫斑点检测 评价研究 

分 类 号：R52[医药卫生—内科学]