T细胞酶联免疫斑点试验在结核病诊断中的应用价值  

Evaluation of TSPOT.TB in the diagnosis of tuberculosis

作　　者：曹敏 顾英 CAO Min;GU Ying(Department of Clinical Laboratory,Shanghai Songjiang District Central Hospital,Shanghai 201600)

机构地区：[1]上海市松江区中心医院检验科,上海201600

出　　处：《医学检验与临床》2023年第6期34-39,共6页Medical Laboratory Science and Clinics

摘　　要：目的:探讨T细胞酶联免疫斑点试验(TSPOT.TB)在结核病诊断中的实际应用价值。方法:回顾性分析2020年10月-2021年10月在松江区中心医院就诊的疑似结核病病例,从中筛选出同时完成TSPOT.TB、TB-Ab、MTB涂片、MTB培养和GeneXpert的病例248份。比较这五种方法的敏感度和特异度,同时分析TSPOT.TB在菌阴性肺结核、菌阳性肺结核、活动性肺结核、潜伏性肺结核和陈旧性肺结核中的阳性率和斑点数差异。结果:这五种检测方法的敏感度分别为87.50%、29.17%、22.22%、37.50%、38.89%;这五种检测方法的特异度分别为82.95%、88.64%、100%、100%、99.43%。TSPOT.TB的敏感度高于其他四组,差异具有统计学意义(P<0.05)。TSPOT.TB特异度与TB-Ab比较,差异无统计学意义(P>0.05),但两者与MTB涂片、MTB培养、GeneXpert相比,差异具有统计学意义(P<0.05)。TSPOT.TB在菌阴性肺结核和菌阳性肺结核中的阳性率及斑点数差异无统计学意义(P>0.05)。T-SPOT.TB在肺结核三个亚组中阳性率差异无统计学意义(P>0.05),活动性肺结核与陈旧性肺结核中斑点数差异有统计学意义(P<0.017),潜伏性肺结核斑点数与另外两组差异无统计学意义(P>0.017)。结论:T-SPOT.TB快速敏感具有极高的阴性预测价值,在结核病诊断中具有良好的应用前景,但T-SPOT.TB不能有效区分活动性、潜伏性以及陈旧性结核感染,因而需要进一步探索新的指标及试验或联合其他的方法分析。Objective:To explore the application value of tuberculosis-specific enzyme-linked immune-spot assay(T-SPOT.TB)in the diagnosis of tuberculosis.Methods:From October 2020 to October 2021,248 suspected tuberculosis cases in Central Hospital of Songjiang District were retrospectively analyzed,which underwent TSPOT.TB,TB-AB,MTB smear,MTB culture and GeneXpert simultaneously.The sensitivity and specificity of these five methods were compared,and the difference of positive rate and spot number of TSPOT.TB in bacteria negative tuberculosis,bacteria positive tuberculosis,active tuberculosis,latent tuberculosis and old tuberculosis were analyzed.Results:The sensitivity of these five methods were 87.50%,29.17%,22.22%,37.50%and 38.89%,respectively.The specificity of these five methods were 82.95%,88.64%,100%,100%and 99.43%,respectively.The sensitivity of TSPOT.TB was significantly higher than that of the other four groups(P<0.05).In terms of specificity,there was no significant difference between TSPOT.TB and TB-AB(P>0.05),However,compared with MTB smear,MTB culture and GeneXpert,the differences were statistically significant(P<0.05).There was no significant difference in the positive rate and spot number of TSPOT.TB between bacteria positive tuberculosis and bacteria negative tuberculosis(P>O.05).In addition,the difference of positive rate about TSPOT.TB in the three subgroups of tuberculosis was not significant(P>0.05).For spot number,the difference of TSPOT.TB between active tuberculosis and old tuberculosis was statistically significant(P<0.017),however,there was no significant difference in the number of latent tuberculosis spots between the other two groups(P>0.017).Conclusion:T-SPOT.TB has a good application prospect in the diagnosis of tuberculosis which is fast,sensitive and has a very high negative predictive value.However,TSPOT.TB cannot effectively distinguish between active,latent and old tuberculosis infection,so it is necessary to further explore new metrics and experiments or combine other methods.

关 键 词：T细胞酶联免疫斑点试验 菌阴性肺结核 菌阳性肺结核 活动性肺结核 潜伏性肺结核 

分 类 号：R521[医药卫生—内科学]