肺结核活动程度对结核感染T细胞斑点试验反应强度的影响  

Effect of Activity of Tuberculosison Response Intensity of T Cell Spot Test for Tuberculosis Infection

作　　者：万荣 李明武 李光妹 朱惠琼 马萌 刘才 WAN Rong;LI Ming-wu;LI Guang-mei;ZHU Hui-qiong;MA Meng;LIU Cai(Dept.of Tuberculosis,The Third People's Hospitalof Kunming,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院结核二科,云南昆明650041

出　　处：《昆明医科大学学报》2020年第9期102-106,共5页Journal of Kunming Medical University

基　　金：昆明市卫计委医药卫生科技计划项目(2018-03-08-003)。

摘　　要：目的探讨肺结核活动程度对结核感染T细胞斑点试验反应强度的影响。方法选取2018年6月至12月期间在昆明市第三人民医院结核二科400例活动性肺结核患者,所有患者均进行了结核感染T细胞斑点试验(T-SPOT.TB),对比分析活动性肺结核患者,在不同病情状态下,T-SPOT.TB的免疫强度。结果180例病原学阳性肺结核,T-SPOT.TB阳性率为96.1%(173/180);220例病原学阴性肺结核,T-SPOT.TB阳性率86.4%(190/220),两者χ2检验比较差异有统计学意义(χ2=11.205,P=0.001<0.05);两组中抗原ESAT-6阳性率比较差异有统计学意义(χ2=12.753,P=0.000<0.05),抗原CFP-10阳性率比较差异无统计学意义(χ2=2.482,P=0.115>0.05)。病原学阳性且T-SPOT.TB阳性173例肺结核患者中,按照抗酸杆菌涂片量(1条~1+、2+、3+、4+)进行分组比较,4组抗原ESAT-6、CFP-10进行比较,差异无统计学意义(P=0.792,0.595,均>0.05);按治疗史分为初治、复治肺结核,两组间抗原ESAT-6、CFP-10比较,其中抗原ESAT-6在初、复治肺结核比较中有统计学差异(Z=-2.178 P=0.005<0.05),抗原CFP-10比较无统计学差异(Z=-0.856,P=0.392>0.05);按照耐药状况分非耐药、耐药肺结核,两组间抗原ESAT-6、CFP-10比较无统计学差异(P=0.748,0.845,均>0.05)。结论结核感染T细胞斑点试验对诊断活动性肺结核的敏感性较好,利用其应答强度反映结核感染活动程度有一定临床意义。Objective To investigate the effect of the activity of tuberculosis on the response intensity of T cell spot test for tuberculosis infection(T-SPOT.TB).Methods From June to December 2018,400 patients with active tuberculosis receiving T-SPOT.TB in the No.2 Department of Tuberculosis in theThird People's Hospital of Kunming were selected.The immunization intensity of T-SPOT.TB in patients with active tuberculosis was comparatively analyzed under the different conditions.Results A total of 180 patients showed pathogenic positive tuberculosis,with the positive rate of T-SPOT.TB being 96.1%(173/180),and the other 220 patients had pathogenic negative tuberculosis,with the positive rate of T-SPOT.TB being 86.4%(190/220),presenting a statistical difference by the Chi-square test(χ2=11.205,P=0.001<0.05).A statistical difference was found in the positive rate of antigen ESAT-6 between the two groups(χ2=12.753,P=0.000<0.05),but not in the positive rate of antigen CFP-10(χ2=2.482,P=0.115>0.05).Among 173 patients with pathogenic positive and T-SPOT.TB-positive tuberculosis,antigens ESAT-6 and CFP-10 showed no statistical differences based on the amount of acid-fast bacilli smear(1~1+,2+,3+and 4+)(P=0.792 and 0.595,both P>0.05).According to the history of treatment,the patients were divided into both the primary treatment and retreatment groups.A statistical difference was found in ESAT-6(Z=-2.178,P=0.005<0.05)but not in CFP-10(Z=-0.856,P=0.392>0.05)between the primary treatment and retreatment groups.ESAT-6 and CFP-10 demonstrated no statistical differences between the patients with non-drug-resistant and drug-resistant tuberculosis(P=0.748 and 0.845,both>0.05).Conclusion The sensitivity of T-SPOT.TB in the diagnosis of active tuberculosis is high.It is of certain clinical significance to use its response intensity to reflect the activity of tuberculosis infection.

关 键 词：结核感染T细胞斑点试验 ESAT-6 CFP-10 结核感染活动程度 免疫强度 

分 类 号：R521[医药卫生—内科学]