T细胞斑点试验技术在结核性胸膜炎诊断中的价值

The significance of T-SPOT.TB test in the diagnosis of tuberculous pleurisy

目的探讨结核分枝杆菌T细胞斑点试验(T-SPOT.TB)技术在结核性胸膜炎诊断以及鉴别诊断中的临床应用价值。方法受试者共124例,包括健康对照者30名、初诊结核性胸膜炎患者37例、恶性胸腔积液患者32例、非结核性胸膜炎患者25例。用T-SPOT.TB测试上述受试者的外周血单个核细胞(PBMC)中对结核分枝杆菌早期分泌靶向抗原6(ESAT-6)和/或培养滤液蛋白10(CFP-10)致敏的T细胞,并与其他相关指标[腺苷脱氨酶(ADA)、结核抗体(TB-Ab)、涂片]进行比较。结果结核性胸膜炎组T-SPOT.TB检测阳性率为91.9%,显著高于健康对照组(0.0%)、恶性胸腔积液组(9.4%)和非结核性胸膜炎组(8.0%),差异具有统计学意义(P<0.05)。T-SPOT.TB对结核性胸膜炎诊断的敏感性、特异性和诊断准确率分别为91.9%、90.6%、91.3%,优于ADA和TB-Ab。结论 T-SPOT.TB可用于结核性胸腔积液的鉴别诊断。在诊断结核性胸膜炎时T-SPOT.TB获得了较高的敏感性、特异性和诊断准确率。T-SPOT.TB作为辅助诊断结核性胸膜炎的方法值得在临床推广及应用。

Objective To investigate the clinical application significance of Mycobacterium tuberculosis T cell enzyme-linked immunospot tuberculous test （T-SPOT. TB test ） in the diagnosis and differentiated diagnosis of tuberculous pleurisy. Methods A total of 124 participants were enrolled in this study, including 30 healthy controls, 37 patients with tuberculous pleurisy, 32 patients with malignant pleural effusion and 25 patients with non-tuberculous pleurisy. The T cells to early secretary antigentie target 6 （ESAT-6） and/or euhure filtrate protein 10 （CFP-IO） sensitive in peripheral blood mononuclear cell （PBMC） of participants were determined by T-SPOT. TB test. The results were compared with other related indicators [ adenosine deaminase （ADA）, tuberculosis antibody （TB-Ab） and smear]. Results The positive rate of the tuberculous pleurisy group （91.9%） by T-SPOT. TB test was significantly higher than those of healthy control group （0.0%）, malignant pleural effusion group （9.4%） and non-tuberculous pleurisy group（ 8.0% ）. The differences were statistically significant （P 〈 0. 05 ）. The sensitivity, specificity and diagnostic accuracy in the diagnosis of tuberculous pleurisy by T-SPOT. TB test were 91.9%, 90.6% and 91.3%, which were superior to ADA and TB-Ab. Conclusions T-SPOT. TB test is useful for the differentiated diagnosis of tuberculous pleural effusion. It has high sensitivity, specificity and diagnostic accuracy in the diagnosis of tuberculous pleurisy. Therefore, T-SPOT. TB test is worth in the clinical extention and application, and would be a supplement for the diagnosis of tuberculous pleurisy.