结核杆菌T细胞斑点试验在克罗恩病与肠结核鉴别诊断中的应用价值

The application value of T-cell spot of tuberculosis test in differential diagnosis of Crohn＇.s disease and intestinal tuberculosis

目的评价结核杆菌T细胞斑点试验（T—spot．TB）在克罗恩病（CD）与肠结核鉴别诊断中的价值。方法采集2010年5月至2010年10月第四军医大学西京医院126例患者的外周静脉血标本，密度梯度离心法分离外周血单个核细胞，根据试剂盒说明书操作步骤进行T-spot．TB。结合临床表现、影像学、内镜、病理检查、其他实验室检查及对经验性抗结核治疗的反应作出CD及肠结核的临床诊断。分析T—spot．TB诊断CD和肠结核的敏感度与特异度。结果确诊CD患者15例[11．9％（15／126）]，肠结核患者14例[11．1％（14／126）]，肠外结核患者40例[31．7％（40／126）]。CD、肠结核、肠外结核、其他疾病患者T-spot．TB阳性率分别为1／15、12／14、70％（28／40）、0％（0／57），各组间差异有统计学意义（P=0．00）。CD与肠结核者的T—spot．TB阳性率间差异有统计学意义（x2=70．58，P=0．00）。T-spot．TB检测CD的敏感度和特异度分别为93．3％（14／15）和87．5％（14／16），检测肠结核时则分别为85．7％（12／14）和93．3％（14／15），CD的阴性预测值[87．5％（14／16）]高于肠结核的阴性预测值[12．5％（2／16）]。结论T—spot．TB检测有助于鉴别诊断CD与肠结核。

Objective To evaluate the value of T-cell spot of tuberculosis test （T-spot. TB） in differential diagnosis of Crohn＇s disease and intestinal tuberculosis. Methods From May 2010 to October 2010, in Xijing hospital, Fourth Military Medical University, the peripheral blood samples of 126 patients were collected and peripheral blood mononuclear cells were isolated with density gradient centrifugation. T-spot. TB was conducted according to the kit instructions. The clinical diagnosis of Crohn＇s disease and intestinal tuberculosis was according to clinical manifestations, imaging, endoscopy, pathology, laboratory tests and on empirical anti-TB treatment response. The sensitivity and specificity of T-spot.TB in diagnosis of Crohn＇s disease and intestinal tuberculosis was analyzed. Results Fifteen patients were diagnosed as Crohn＇s disease （11. 9%, 15/126）, 14 patients were intestinal tuberculosis （11.1%, 14/126） and 40 patients were extraintestinal tuberculosis （31.7 %, 40/126）. The positive rate of T- spot. TB in Crohn＇s disease, intestinal tuberculosis, extra-intestinal tuberculosis and other diseases was 1/15, 12/14, 70% （28/40） and 0% （0/57）, respectively. The difference between the groups was statistically significant （P = 0. 00）. There was statistically significant difference of T-spot. TB positive rate between Crohn＇s disease and intestinal tuberculosis （X2 = 70.58, P：0.00）. The sensitivity and specificity of T- spot.TB in Crohn＇s disease detection was 93.3%（14/15） and 87. 5%（14/16）, in intestinal tuberculosis was 85. 7% （12/14） and 93. 3% （14/15）. The negatively predictive value of Crohn＇s disease was higher [87.5% （14/16）] than that of intestinal tuberculosis [12.5% （2/16）]. Conclusion T-spot.TB is helpful for differential diagnosis of Crohn＇s disease and intestinal tuberculosis.