结核分枝杆菌特异性蛋白抗体检测在结核病诊断中的价值

The clinical significance of serum tuberculosis specific antigen antibody in the diagnosis of tuberculosis

目的研究结核分枝杆菌特异性蛋白(TB-SA)抗体检测在结核病诊断中的价值。方法对829例结核病患者(男471例,女358例)、278例非结核性肺部疾病患者(男172例,女106例)和125例健康志愿者(男51例,女74例)同时进行结核菌素纯蛋白衍生物(PPD)试验,结核分枝杆菌TB-SA 抗体检测,并对全部肺结核和非结核性肺部疾病患者进行痰抗酸杆菌涂片和培养。采用EPI2000统计软件进行统计学分析,组间比较采用 t 检验,计数资料采用X^2检验。结果结核分枝杆菌 TB-SA 抗体检测诊断菌阳肺结核的敏感度为75.1%(272/362);诊断菌阴肺结核的敏感度为68.9%(226/328);诊断肺外结核病的敏感度为71.2%(99/139);诊断结核病的总体敏感度为72.0%(597/829),特异度为82.1%(331/403)。TB-SA 血清抗体检测值并不与 PPD 值呈线性关系,即结核分枝杆菌 TB-SA 抗体检测诊断结核病不受卡介苗接种反应的影响。结论结核分枝杆菌 TB-SA 抗体检测诊断结核病有较好的敏感度和特异度,是辅助诊断和鉴别诊断结核病的有效手段。

Objective To evaluate the significance of serum tuberculosis specific antigen （TB-SA） antibody detection in the diagnosis of tuberculosis. Methods TB-SA antibody in the serum samples from 829 cases of tuberculosis, 278 patients with non-tuberculosis lung diseases and 125 healthy volunteers were detected using enzyme-linked immunosorbent assay （ELISA）. Tuberculosis was confirmed by clinical, bacteriology, X-ray examination and pathology studies. Results The sensitivity of TB-SA antibody in diagnosis of bacteriologically positive and negative pulmonary tuberculosis and extrapulmonary tuberculosis was 75.1% （272/362）, 68. 9% （226/328） and 71.2% （99/139）, respectively; the combined sensitivity was 72. 0% （597/829） ,and the specificity 82. 1% （331/403）. The relationship between the OD405 of TB- SA antibody and PPD positivity showed no linear relationship, suggesting that BCG vaccination did not affect the value of serum TB-SA antibody. Conclusion The results suggest that measurement of serum TB-SA is a relatively sensitive and specific method for the diagnosis and differential diagnosis of tuberculosis.