结核感染T细胞斑点实验在肺结核中的临床应用研究

The clinical applications of T SPOT. TB in pulmonary tuberculosis patients

目的探讨结核感染T细胞斑点实验(T SPOT.TB)在肺结核中的应用价值。方法 193例疑似肺结核患者进行痰涂片、痰培养、结核菌素皮试(TST)及T SPOT.TB检测;另选健康志愿者20名进行TST及T SPOT.TB检测。结果以随访后临床诊断结果为金标准,T SPOT.TB检测敏感度高于涂片镜检、固体培养及TST,差异均有统计学意义(χ2值分别为105.2、62.6、29.0,P<0.01);T SPOT.TB检测特异度低于涂片镜检及固体培养,但高于TST,差异均有统计学意义(χ2值分别为18.5、21.6、15.2,P<0.01)。在痰培养阳性或阴性肺结核中,T SPOT.TB灵敏度高于TST,而在非结核患者及健康人群,T SPOT.TB特异度高于TST,差异均有统计学意义(P<0.05)。免疫抑制组PPD硬结直径明显小于正常组,差异有统计学意义(P<0.05);但免疫抑制组与正常组EAST-6及CFP-10的斑点数差异无统计学意义(P>0.05)。结论 T SPOT.TB有助于提高结核检出率,可作为临床鉴别结核感染的辅助诊断,具有一定的临床推广价值。

Objective To explore the clinical values of T SPOT. TB in the diagnosis of pulmonary tuberculosis patients. Methods 193 patients with a suspicion of pulmonary tuberculosis were conducted for sputum smear,sputum culture,tuberculin skin test（ TST） and T SPOT. TB testing. 20 healthy controls were collected and conducted for TST and T SPOT. TB tests.Results Regarding the clinical diagnosis results as the gold standard after the follow-up,the sensitivity of detection with T SPOT. TB was higher than smear,solid culture and TST,and the differences were statistically significant（ χ2= 105. 2,62. 6,29. 0,respectively,P〈0. 01）; and the detection specificity with T SPOT. TB was lower than smear and solid culture,but higher than TST,with the differences statistically significant（ χ2= 18. 5,21. 6,15. 2,P〈0. 01）. The sensitivity of T SPOT. TB was higher than TST in sputum culture-positive or culture-negative,and the specificity of T SPOT. TB was higher than TST in non-TB patients and healthy controls,with the differences statistically significant（ P〈0. 05）. The PPD induration diameter of immunosuppressive group was significantly lower than that of the control group,and the difference was statistically significant（ P〈0. 05）; but difference on spots numbers of EAST-6 and CFP-10 in the immunosuppression group and the normal group had no statistical significance（ P〈0. 05）. Conclusion T SPOT. TB can enhance the detection rate of tuberculosis. It has certain value of clinical promotion.