结核抗体蛋白芯片技术与TB-IGRA对结核病活动度及疗效的监测价值  

The value of tuberculosis antibody protein chip technique and TB-IGRA in monitoring the activity and efficacy of tuberculosis

作　　者：冯英凯[1] 王勇[2] 黄正谷 赵小莉[3] 刘英 

机构地区：[1]重庆市中医院道门口院部呼吸内科,400011 [2]重庆市公共卫生医疗救治中心普内科,400036 [3]重庆市公共卫生医疗救治中心检验科,400036 [4]重庆市结核病防治所,400050

出　　处：《检验医学与临床》2018年第1期4-8,共5页Laboratory Medicine and Clinic

基　　金：重庆市卫生和计划生育委员会医学科研重点项目(2013-1-038)

摘　　要：目的明确蛋白芯片技术、γ-干扰素释放试验(TB-IGRA)两项检测技术对结核病活动度和疗效的监测价值。方法 655例结核病患者按病变部位分为肺结核组(432例)、肺外结核组(146例)和肺结核并肺外结核组(77例),以非结核患者(248例)作为非结核对照组。应用蛋白芯片技术、TB-IGRA对各组治疗前、治疗过程中及治疗结束后6、12个月的标本进行平行检测,比较抗结核疗程中不同时相点检测阳性率的动态变化,并与集菌涂片法结果进行同步比较分析。结果随着抗结核治疗的进行,蛋白芯片技术和TB-IGRA检出阳性率均呈下降趋势。蛋白芯片技术阳性率在初治满3个月前均低于TB-IGRA,在初治满4个月时开始下降,但下降幅度低于TB-IGRA,此后下降幅度逐渐增大,在治疗结束后6个月时阳性率仍高达18.78%,治疗结束后12个月时阳性率仍为15.27%。TB-IGRA阳性率在初治满2个月时即有明显下降,下降幅度高于蛋白芯片技术,在复治满8个月时阳性率降至8.85%,治疗结束后6个月时阳性率降至6.26%,治疗结束后12个月时阳性率降至3.82%,明显低于同时相点蛋白芯片技术。在初治满4个月之前,蛋白芯片技术与涂片结果的诊断符合率高于TB-IGRA,在初治满5个月时略下降,之后,随着疗程的进展,蛋白芯片技术与涂片结果的诊断符合率逐渐增高,但幅度均低于TB-IGRA。TB-IGRA与涂片结果的诊断符合率在初治满3个月前较低,此后随着疗程的进展,诊断符合率逐渐增高。结论蛋白芯片技术与TB-IGRA对结核疗效均有监测价值,初治满4个月之前,蛋白芯片技术监测价值高于TB-IGRA;初治满4个月之后,蛋白芯片技术监测价值低于TB-IGRA。两种检测方法各有其优缺点,二者结合有良好的互补效应,蛋白芯片技术与TB-IGRA联合检测对结核病活动度评估和抗结核疗效监测有较高的临床价值。Objective The aim of the study is to determine the value of protein chip technique and TB interferon gamma release test(TB-IGRA)for the detection of tuberculosis activity and efficacy.Methods According to lesion distribution,a total of 655 patients with tuberculosis were divided into three groups:pulmonary tuberculosis group,extrapulmonary tuberculosis group,and pulmonary&extrapulmonary tuberculosis group,with non-tuberculosis patients as the control group.Protein chip technique and TB-IGRA were adopted to compare the dynamic changes of the positive rates at different time points(prior treatment,during therapeutic process,6 and 12 months after end-of-treatment)in each group.The above results were compared and analyzed with the results of bacteria-collecting smear method synchronously.Results The results showed that the positive rates of protein chip technique and TB-IGRA were decreased with the course of anti-tuberculous therapy.The positive rate of protein chip technique was lower than that of TB-IGRA during three-month initial treatment period,began to decline at the fourth month time-point,and less than that of TB-IGRA,then decreased gradually.The positive rate was still respectively 18.78% and 15.27% at 6-month time-point and 12-month time-point after the end of treatment.The positive rate of TB-IGRA was evidently declined in initial treatment for 2 months,and the decline rate was higher than that of protein chip technique.With regard to TBIGRA,the positive rate fell to 6.26% and 3.82%respectively at 8-month time-point and 12-month time-point in retreatment cases,significantly lower than that of protein chip technique at the same time-points.With bacteria-collecting smear method as the reference,the diagnostic coincidence rate of protein chip technique was higher than that of TB-IGRA before initial treatment for 4 months,decreased slightly at the fifth month timepoint in initial treatment,and then increased gradually with the progress of the treatment.Conclusion It is suggested that the protein chip technique

关 键 词：蛋白芯片 结核 Γ-干扰素释放试验 

分 类 号：R446.5[医药卫生—诊断学]