T-SPOT.TB对免疫低下合并结核性胸膜炎患者的诊断价值

Diagnostic value of T-SPOT.TB for tuberculous pleurisy in immunocompromised patients

目的:探讨结核杆菌T细胞斑点实验(T-SPOT.TB)对免疫低下合并结核性胸膜炎患者的诊断价值。方法:比较T-SPOT.TB、腺苷脱氨酶(ADA)、TB-DNA法及结核抗体检测54例免疫低下合并结核性胸膜炎患者的诊断灵敏度。其中有22例患者在抗结核治疗第2个月末复查T-SPOT.TB,比较治疗前后TSPOT.TB斑点形成细胞数的变化。结果 :在对54例确诊为免疫低下合并结核性胸膜炎患者中,T-SPOT.TB诊断灵敏度(79.63%)显著高于ADA(64.81%)、TB-DNA(48.15%)及结核抗体(55.56%)(P<0.05)。22例患者在抗结核治疗2个月后复查T-SPOT.TB值,T-SPOT.TB阳性率为90.91%,较治疗前无明显变化(P>0.05)。测试孔A和B斑点细胞数(SFC)较治疗前下降((t=2.728和2.400,均P<0.05)。结论 :T-SPOT.TB诊断免疫低下合并结核性胸膜炎患者具有良好的灵敏度,且对其诊断具有重要临床价值。

Objective To explore the clinical value of tuberculous infection of T cells spot test （T-SPOT. TB）for diagnosing tuberculous pleurisy in immunoeompromised patients. Methods The sensitivities of T-SPOT. TB, ADA, TB-DNA and tuberculosis antibodies to tuberculous pleurisy in 54 immunocompromised patients were compared.Among these patients, 22 were retested by T-SPOT. TB after 2 months anti-tuberculosis treatment. Spot forming eells（SFCs） were compared before and after treatment. Results The diagnostic sensitivity of T-SPOT.TB （79.63%）was significantly higher than those of ADA （64.81%）,TB-DNA （48.15%）and tuberculosis antibodies （55.56%） （P〈0.05）.22 patients were retested by the T-SPOT.TB after anti-TB treatment（2 months）, the results showed that the positive rate of T-SPOT.TB was 90.91% ,not significantly than previous tests （P〈0.05）.Both ESAT-6 and CFP-10 specific SFCs decreased significantly compared with those before anti-TB treatment （t= 2.728 and 2.400,P〈0.05 respectively）. Conclusions T-SPOT.TB assay has satisfactory sensitivity and could be used in diagnosis of tuberculous pleurisy in immunocompromised patients.