酶联免疫斑点试验在骨关节结核中的辅助诊断价值

Enzyme-linked immunospot assay in the diagnosis of osteoarticular tuberculosis

目的探讨评价酶联免疫斑点试验(ELISPOT)在骨关节结核病中的辅助诊断价值。方法对骨关节结核病组30例和对照组21例患者,应用ELISPOT试验检测结核菌特异性6kD早期分泌靶向抗原(ESAT-6)和10kD培养滤过蛋白(CFP-10)刺激后外周血中释放γ-干扰素的特异性T细胞。同时对关节穿刺液或手术标本进行涂片、培养、聚合酶链反应(PCR)检测结核菌特异DNA以及病理检查诊断。结果骨关节结核病患者中ELISPOT检测敏感性为96.7%(29/30),特异性为76.2%(16/21),阳性预测值、阴性预测值和阳性似然比分别为85.3%、94.2%和2.86。抗酸杆菌涂片、结核菌培养、PCR和病理诊断的敏感性分别为23.3%(7/30),30.0%(9/30),46.7%(14/30)和93.3%(28/30)。结论 ELISPOT检测方法在骨关节结核病中具有一定的辅助诊断价值,其敏感性明显高于临床常规检测方法。

Objective The purpose of this study was to evaluate the performance of enzyme-linked immunospot assay （ELISPOT） for the diagnosis of osteoartieular tuberculosis （TB）. Methods Thirty patients with osteoarticular TB and 21 patients without osteoarticular TB were studied. ELISPOT assay was used to measure the interferon gamma （IFN-γ） response to the TB-specific antigens early secretory antigenic target-6 （ESAT-6） and culture filtrate protein-10 （CFP-10） in T cells in samples of peripheral blood mononuclear cells（PBMC）. Results The sensitivity, specificity, positive predic-tive value, negative predictive value and positive likelihood ratio for the osteoarticular TB diagnosis by the ELISPOT assay were 96.7%, 76.2%, 85.3% , 94.2% and 2.86, respectively. The sensitivity of smear, culture, PCR and pathological diag-nosis were 23.3%, 30.0%, 46.7% and 93.3%, respectively. Conclusion The data on this subject suggest that the ELISPOT assay can be an useful tool in diagnosing osteoarticular TB infection and is more sensitive than other common detection methods.