新型LTT优化试验诊断抗结核药物超敏反应的临床价值  

Clinical value of a new optimized LTT test in diagnosis of hypersensitivity induced by antituberculosis drugs

作　　者：谢知兵 李勇忠 于红缨 王培 蒋小欢 XIE Zhi-bing;LI Yong-zhong;YU Hong-ying;WANG Pei;JIANG Xiao-huan(Huaihua First Hospital,Huaihua,Hunan 418000,China)

机构地区：[1]怀化市第一医院感染科,湖南怀化418000

出　　处：《中华医院感染学杂志》2022年第5期646-649,共4页Chinese Journal of Nosocomiology

基　　金：湖南省自然基金资助项目(S2019JJMSXM0810)。

摘　　要：目的 研究新型淋巴细胞转化试验(LTT)在诊断抗结核药物超敏反应中的临床价值。方法 选择2018年10月-2019年3月于怀化市第一人民医院确诊的初治结核病和肺外结核病患者90例,以临床药物激发试验(DPT)检测为判定超敏反应的金标准。采集患者外周静脉血进行传统LTT和新型LTT,比较两种方法的体外刺激指数(S.I),检测灵敏度、特异度、假阳性率、假阴性率、阳性预测值和阴性预测值。结果 在DPT阳性患者中,新型LTT的刺激指数均高于传统LTT(P<0.05);DPT共检测出53例抗结核药物所致的超敏反应,新型LTT共检测出阳性例数41例,传统LTT共检测出阳性例数29例,新型LTT检测的阳性例数高于传统LTT检测例数(F=3.572,P=0.007);新型LTT对不同药物导致超敏反应的检测灵敏度均高于传统LTT,假阴性率低于传统LTT。结论 新型LTT可显著提高传统LTT的灵敏度,降低假阴性率,可在抗结核药物超敏反应的临床诊断中推广应用。OBJECTIVE To study the clinical value of a new lymphocyte transformation test(LTT) in diagnosis of hypersensitivity induced by antituberculosis drugs. METHODS A total of 90 patients who were diagnosed with initial treatment of tuberculosis and extrapulmonary tuberculosis in Huaihua First Hospital from Oct 2018 to Mar 2019 were enrolled in the study. The clinical drug provocation testing(DPT) was set as the golden standard for determination of hypersensitivity. The peripheral venous blood specimens were collected for traditional LTT and new LTT, the external stimulation index(S.I) was compared between the two methods, the sensitivity, specificity, false negative rate, false positive rate, positive predictive value and negative predictive value were detected. RESULTS Among the patients positive for DPT, the S.I of the new LTT was significantly higher than that of the traditional LTT(P<0.05). Totally 53 cases of antituberculosis drugs-induced hypersensitivity were detected by DPT, 41 cases were tested positive by new LTT, 29 cases were tested positive by traditional LTT, the number of cases tested positive by the new LTT was significantly larger than that by the traditional LTT(F=3.572,P=0.007). The sensitivity of the new LTT was higher than that of the traditional LTT in detection of the drugs-induced hypersensitivity, and the false negative rate of the new LTT was lower than that of the traditional LTT. CONCLUSION The new LTT can remarkably raise the sensitivity of the traditional LTT and reduce the false negative rate, it can be used for clinical diagnosis and application of antituberculosis drugs in clinical diagnosis with hypersensitive reaction.

关 键 词：抗结核药 超敏反应 淋巴细胞转化试验 CD3^(+)CD_(25)Int/LowT细胞 

分 类 号：R978.3[医药卫生—药品]