外周血miR-29a和T细胞斑点试验在活动性肺结核患者中的临床意义  

Diagnose value of miR-29a and T-SPOT assay in active pulmonary tuberculosis patients

作　　者：詹燏[1] 刘水逸[1] 刘怡雯[1] 柳洪周 周书天 李迅[1] 汪慧[1] 卢忠心[1] ZHAN Yu;LIU Shuiyi;LIU Yiwen;LIU Hongzhou;ZHOU Shutian;LI Xun;WANG Hui;LU Zhongxin(Department of Clinical Laboratory,The Central Hospital of Wuhan,Wuhan,430014,China)

机构地区：[1]武汉市中心医院检验科

出　　处：《临床血液学杂志（输血与检验）》2019年第5期765-768,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：武汉市卫生和计划生育委员会科研项目(No:WX14C14);武汉市中心医院院内科研基金项目计划(青年基金)(No:YQ13A04)

摘　　要：目的:对活动性肺结核患者外周血miR-29a的表达及其临床意义进行探讨,并对结核感染T细胞斑点试验(T-SPOT)在活动性肺结核诊断中的价值及临床意义进行探讨。方法:患者来自2015-10—2017-10呼吸与危重症医学科专科门诊收治的活动性肺结核患者151例及同一段时间收治的非结核的肺炎患者78例,采集2组患者的外周血,运用逆转录荧光定量PCR(qRT-PCR)检测各组外周血miR-29a水平,miR-29a的诊断价值的评估采用受试者工作特征曲线(ROC曲线)。同时采用T-SPOT试验进行检测,采用ROC曲线分别评估TSPOT试验中早期分泌性靶抗原6(EAST-6抗原)和滤液培养蛋白10(CFP-10抗原)的诊断价值,并对EAST-6抗原和CFP-10抗原联合后的诊断价值进行评估。结果:活动性肺结核组的外周血miR-29a的水平显著比对照组高,差异有统计学意义(P<0.01)。miR-29a的敏感度94.1%,特异度63.6%,ROC曲线下面积0.878。EAST-6抗原、CFP-10抗原及此2种抗原联合在活动性肺结核患者和非结核患者间差异有统计学意义(P<0.01)。EAST-6抗原的敏感度90.2%,特异度86.4%,ROC曲线下面积0.892。CFP-10抗原的敏感度80.4%,特异度90.9%,ROC曲线下面积0.873。EAST-6抗原和CFP-10抗原联合检测的敏感度81.8%,特异度92.2%,ROC曲线下面积0.908。结论:活动性肺结核患者血浆miR-29a表达水平的检测可作为活动性肺结核诊断的潜在生物学标志。T-SPOT试验在活动性肺结核的诊断中具有较高价值,是一项值得广泛应用的结核诊断试验。Objective:To analyze the changes and significance of the expression of miR-29a in peripheral blood with active pulmonary tuberculosis patients,and evaluate the value of T-SPOT.TB test in the diagnosis of active pulmonary tuberculosis patients.Method:151 patients with active pulmonary tuberculosis and 78 patients with pneumonia were collected from October 2015 to October 2017.The expression level of miR-29a in the peripheral blood was detected with qRT-PCR.MiR-29a and T-SPOT.TB were compared between TB patients and pneumonia patients.Receiver operating characteristic curve(ROC)was employed to evaluate the diagnostic value of miR-29a and T-SPOT in active pulmonary tuberculosis.Result:The expression level of miR-29a in active pulmonary tuberculosis was significantly higher than that of control group(P<0.01).The area under the curve(AUC)was 0.878.The sensitivity was 94.1%and the specificity was 63.6%.The positive rate of T-SPOT was statistically significant(P<0.01)in active pulmonary tuberculosis and control patients.The area under the curve(AUC)was 0.892,0.873 and 0.908,respectively,for EAST-6,CFP-10 and combination of the two antigens.Sensitivity was 90.2%,80.4%and 81.8%,respectively.And specificity was 86.4%,90.9%and 92.2%,respectively.Conclusion:MiR-29 a may be a potential diagnostic marker in active pulmonary tuberculosis patients.T-SPOT might have better diagnostic value in the active pulmonary tuberculosis.

关 键 词：活动性肺结核 miR-29a T-SPOT 

分 类 号：R521[医药卫生—内科学]