检验医学 ›› 2015, Vol. 30 ›› Issue (3): 254-257.DOI: 10.3969/j.issn.1673-8640.2015.03.013

• 技术研究与评价·论著 • 上一篇    下一篇

结核分枝杆菌T细胞斑点试验对结核性胸腔积液诊断价值的研究

许雪成1, 茅利明2   

  1. 1.绍兴县柯桥街道社区卫生服务中心检验科,浙江 绍兴 312030
    2. 绍兴县中心医院检验科,浙江 绍兴 312030
  • 收稿日期:2014-02-10 出版日期:2015-03-30 发布日期:2015-04-16
  • 作者简介:null

    作者简介:许雪成,男,1977年生,主管技师,主要从事临床检验工作。

Study on the diagnostic significance of T cells spot test in Mycobacterium tuberculosis infected patients with pleural effusion

XU Xuecheng1, MAO Liming2   

  1. 1. Department of Clinical Laboratory, Keqiao Community Health Center, Zhejiang Shaoxing 312030, China
    2. Department of Clinical Laboratory, Shaoxing County Central Hospital, Zhejiang Shaoxing 312030, China
  • Received:2014-02-10 Online:2015-03-30 Published:2015-04-16

摘要: 目的

探讨结核分枝杆菌(MTB)T细胞斑点试验(T-SPOT)在疑似MTB感染伴胸腔积液患者快速诊断中的应用价值。

方法

疑似MTB感染伴胸腔积液患者124例,应用T-SPOT检测外周血淋巴细胞对MTB特异性分泌蛋白EAST-6和CFP-10的免疫反应。利用MTB DNA法检测胸腔积液中的MTB,同时用免疫金标法检测血清MTB抗体,并进行统计学分析。

结果

124例疑似患者经过痰和胸腹水抗酸染色镜检、痰液和胸腹水MTB培养、结核菌素皮肤试验、MTB DNA和MTB抗体等试验确诊结核病患者44例,阳性检出率为35.5%。T-SPOT的阳性检出率为33.06%(41/124),MTB DNA的阳性检出率为14.52%(18/124),血清MTB抗体的阳性检出率为 9.68%(12/124)。对已确诊的44例结核病患者进行数据分析,T-SPOT、MTB DNA和血清MTB抗体的准确率分别为86.36%(38/44)、27.27%(12/44)和18.18%(8/44)。T-SPOT的阳性检出率和结核诊断的准确率均显著高于其它2种方法(P<0.05)。T-SPOT对疑似MTB感染的胸腔积液患者诊断的阳性预测值为92.68%,阴性预测值为92.77%。

结论

T-SPOT对疑似MTB感染伴胸腔积液患者的诊断具有快速、高敏感性和高特异性的优点,优于MTB DNA和血清MTB抗体试验,可以作为一种新的技术应用于人体MTB感染的诊断。

关键词: T细胞试验, DNA, 抗体, 结核分枝杆菌, 胸腔积液

Abstract: Objective

To investigate the application significance of Mycobacterium tuberculosis (MTB) T cells spot test (T-SPOT) in the rapid diagnosis for suspected MTB infected patients with pleural effusion.

Methods

The 124 patients with pleural effusion which were suspected as having suspected MTB infection were enrolled. T-SPOT was used to detect the immune response of peripheral blood lymphocyte against MTB special secreted protein EAST-6 and CFP-10. The MTB DNA method was used to detect MTB in pleural effusion, meanwhile serum anti-MTB antibody was detected by immuno-gold filtration assay, and the results were analyzed statistically.

Results

The 44 of 124 cases were diagnosed as tuberculosis by sputum, pleural effusion and ascites smear test, sputum, pleural effusion and ascites MTB culture, tuberculin test, MTB DNA method and anti-MTB antibody test, and the positive rate was 35.5%. The positive rate of T-SPOT in the 124 patients with pleural effusion was 33.06%(41/124). The positive rate of MTB DNA method was 14.52%(18/124), and that of anti-MTB antibody test was 9.68%(12/124). Among the 44 confirmed tuberculosis patients, T-SPOT had the consistency rate of 86.36%(38/44), while the consistency rates of MTB DNA method and anti-MTB antibody test were 27.27%(12/44) and 18.18%(8/44), respectively. The positive rate and consistency rate of T-SPOT were significantly higher than those of the others (P<0.05). The positive and negative predictive values of T-SPOT in suspected MTB infected patients with pleural effusion were 92.68% and 92.77%, respectively.

Conclusions

T-SPOT is fast, sensitive and specific to diagnose the suspected MTB infected patients with pleural effusion. T-SPOT is better than MTB DNA method and anti-MTB antibody test. T-SPOT can become a new diagnostic method to be applied in the diagnosis of MTB infection.

Key words: T cells spot test, DNA, Antibody, Mycobacterium tuberculosis, Pleural effusion

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