酶联免疫斑点试验在脊柱结核辅助诊断应用中的影响因素探讨  

Study on the influencing factors for enzyme-linked immunospot assay in spinal tuberculosis patients

作　　者：袁凯[1] 张顺聪[1] 周腾鹏 马延怀 梁德[1] 吴雪琼[2] 陈建庭[3] YUAN Kai;ZHANG Shuncong;ZHOU Tengpeng;MA Yanhuai;LIANG De;WU Xueqiong;CHEN Jianting(Department of Spine Surgery,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou,Guangdong 510405,China;Army Tuberculosis Key Laboratory,Institute for Tuberculosis Research of the 309th Hospital of PLA,Beijing 100091,China;Department of Spine Surgery,Nanfang Hospital Affiliated to Southern Medical University,Guangzhou,Guangdong 510515,China)

机构地区：[1]广州中医药大学第一附属医院脊柱专科,广东广州510405 [2]中国人民解放军三○九医院全军结核病研究所全军结核病防治重点实验室,北京100091 [3]南方医科大学附属南方医院脊柱专科,广东广州510515

出　　处：《国际检验医学杂志》2019年第12期1448-1452,共5页International Journal of Laboratory Medicine

基　　金：广东省医学科学技术研究基金项目(B2018153);广州中医药大学第一附属医院“创新强院”青年科研人才培优项目(2016QN05)

摘　　要：目的分析脊柱结核患者酶联免疫斑点试验(ELISPOT)结果的相关临床影响因素。方法选取2015年1月至2017年10月脊柱结核感染组患者85例(病例组)和非脊柱结核疾病患者71例(对照组),抽取受试者外周静脉血,应用ELISPOT技术,使用结核分枝杆菌特异性融合抗原CFP-10/ESAT-6作为刺激物进行检测,并详细记录患者基本资料、临床表现等信息,分析临床因素对ELISPOT结果的影响。结果ELISPOT诊断在病例组中的阳性率为83.5%,进一步分析得出:在老年脊柱结核患者中(年龄≥60岁)的阳性率为72.7%,而在年龄<60岁脊柱结核患者中的阳性率高达90.4%,两组结果比较差异具有统计学意义(P<0.05)。身体质量指数(BMI)偏低(BMI≤16kg/m2)脊柱结核组斑点形成细胞(SFC)数目[(25.3±12.8)个]比BMI17~25kg/m2组[(45.2±36.7)个]明显减少,差异有统计学意义(P<0.05);病例组影像学上合并有椎旁脓肿的患者其SFC数目为(48.6±35.8)个,相比较单纯椎体破坏无合并椎旁脓肿者的(25.8±22.9)个,差异有统计学意义(P<0.05)。结论在脊柱结核的实验室辅助诊断中,以结核分枝杆菌特异性融合抗原CFP-10/ESAT-6作为刺激物的ELISPOT试验发挥着一定作用,其诊断结果可能受到年龄、BMI、椎旁脓肿等临床因素影响。Objective To evaluate the clinical influencing factors on the enzyme-linked immune spot test (ELISPOT) in spinal tuberculosis patients. Methods During January 2015 and October 2017,a total of 85 patients with spinal tuberculosis (case group) and 71 healthy subjects (control group) were enrolled and peripheral venous blood samples were collected and detected by ELISPOT using Mycobacterium tuberculosis specific fusion antigen CFP-10/ESAT-6 as a stimulant.The basic information,clinical manifestations of the patients were recorded in details.The influence of clinical factors on ELISPOT results was analyzed. Results The positive rate of ELISPOT in case group was 83.5%.Further analysis showed that the positive rate of ELISPOT in elderly patients with spinal tuberculosis (age ≥ 60 years old) was 72.7%,while that in patients with spinal tuberculosis (age<60 years old) was 90.4%,and and the difference was statistically significant (P<0.05).The mean number of spot-forming cells (SFC) in spinal TB patients with body mass index (BMI)≤16 kg/m 2 was (25.3±12.8),which was lower than (45.2±36.7) of spinal TB patients with BMI 17-25 kg/m 2,and the difference was statistically significant (P<0.05).The mean number of SFC was (48.6±35.8) in spinal TB patients with abscesses,which was significantly higher than (25.8±22.9) of spinal TB patients of simple vertebral body destruction without abscesses,and the difference was statistically significant (P<0.05). Conclusion In the laboratory-assisted diagnosis of spinal tuberculosis,the ELISPOT test using the specific fusion antigen CFP-10/ESAT-6 of Mycobacterium tuberculosis as a stimulant plays a certain role.Its diagnosis results may be influenced by clinical factors such as age,BMI and paravertebral abscess.

关 键 词：脊柱结核 酶联免疫斑点试验 影响因素 

分 类 号：R446.9[医药卫生—诊断学]