结核感染T细胞斑点试验联合淋巴细胞及细胞因子检测在喉结核患者诊治中的应用  

Application of TSPOT.TB combined with detections of lymphocytes and cytokine in diagnosis and treatment of patients with laryngeal tuberculosis

作　　者：蒋杏丽[1] 高志光[1] 赵金花[1] 

机构地区：[1]黑龙江省医院耳鼻喉科,黑龙江哈尔滨150000

出　　处：《中国校医》2015年第6期428-430,共3页Chinese Journal of School Doctor

基　　金：黑龙江省卫生计生委科研项目(2014-154)

摘　　要：目的观察结核感染T细胞斑点试验联合淋巴细胞及细胞因子检测在喉结核患者诊治中的应用效果。方法选择在2009年1月至2014年4月黑龙江省医院耳鼻喉科检查治疗的57例患者作为研究对象,以实验室检查、X线或CT胸片综合检查标准为诊断金标准,最终确诊喉结核患者25例,余下32患者均排除喉结核及其它结核病,所有患者在诊治前后均行结核感染T细胞斑点试验检测,同时检测CD3+、CD4+、CD8+、NK和CD19+淋巴细胞亚群,以及IL-10、IL-17、TNF-α、IFN-γ细胞因子。比较诊断的灵敏度和特异度,并且评价治疗效果。结果 57例患者行T细胞斑点试验检测的灵敏度和特异度比较(χ2=32.250,P=0.000),差异有统计学意义(P<0.05);治疗6月后,对25例喉结核组患者采用T细胞斑点试验检测后,诊断灵敏度为44%(11/25)。喉结核患者治疗前后在CD3+(t=-7.823,P=0.000)、CD4+(t=-4.015,P=0.021)、CD8+(t=-3.981,P=0.037),差异有统计学意义(P<0.05);治疗前后在IL-17(t=9.912,P=0.000)、TNF-α(t=6.882,P=0.000)和IFN-γ(t=-10.821,P=0.000)比较差异有统计学意义(P<0.05)。结论对喉结核患者联合应用结核感染T细胞斑点试验、淋巴细胞及细胞因子检测,能够有效评价喉结核患者的诊治水平,能够有效评价患者的治疗效果,并且能够减少误诊和漏诊率,提高喉结核的诊断阳性率,在临床具有一定的运用价值。Objective To study the application of TSPOT.TB combined with the detections of lymphocytes and cytokine in the diagnosis and treatment of patients with laryngeal tuberculosis. Methods Totally 57 patients who were examined and treated in the ear-nose-throat(ENT) department of Heilongjiang Provincial Hospital were chosen as the study subjects from January 2009 to April 2014, and the comprehensive examination criteria of laboratory tests and X-ray or CT examinations were as the gold standard of diagnosis. A total of 25 persons were finally diagnosed as the patients with laryngeal tuberculosis, and the remaining 32 patients were excluded. All the patients before and after the diagnosis and treatment underwent the TSPOT.TB, and at the same time, the detections of CD3 +, CD4 +, CD8 +, NK, CD19 + lymphocyte subsets,as well as IL-10, IL-17, TNF-α, IFN-γ cytokine were also performed. The sensitivity and specificity of diagnosis were compared and the therapeutic effects were evaluated. Results For the sensitivity and specificity of TSPOT.TB, there was a significant difference among the 57 of patients(χ2= 32.250, P = 0.000). Six months after the treatment, the diagnostic sensitivity of TSPOT.TB was 44% in the 25 laryngeal tuberculosis patients(11/25). Among the laryngeal tuberculosis patients, before and after the treatment, the results of detections of CD3 +(t = 7.823, P = 0.000), CD4 +(t =-4.015, P =0.021), CD8 +(t =-3.981, P = 0.037), IL-17(t = 9.912, P = 0.000), TNF-α(t = 6.882, P = 0.000) and IFN-γ(t =-10.821, P = 0.000) were statistically significant(all P <0.05). Conclusion The combination of TSPOT.TB and detections of lymphocytes and cytokine can improve the diagnosis and treatment levels in laryngeal tuberculosis patients.

关 键 词：结核 喉/诊断 T-淋巴细胞/免疫学 淋巴细胞亚群 白细胞介素-10 肿瘤坏死因子-α 干扰素-Γ 

分 类 号：R529.8[医药卫生—内科学]