γ-干扰素释放试验对活动性肺结核的辅助诊断价值

Auxiliary diagnostic value of interferon-gamma release assay for active tuberculosis

目的探讨结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)在活动性肺结核中的诊断价值。方法应用T-SPOT.TB试剂盒对153例活动性肺结核(A组)和81例其他肺部疾病(B组)患者的外周血中MTB特异性T淋巴细胞进行检测,同时对两组患者进行LAM、16KD、38KD抗体的检测。结果 T-SPOT.TB对活动性肺结核的敏感性为78.4%(120/153),要明显高于对照组24.7%(20/81)(χ~2=80.91,P<0.001)。T-SPOT.TB检测的敏感性要明显高于16KD抗体10.5%(χ~2=52.26,P<0.001)、也要高于38KD抗体(54.9%)、LAM抗体(58.8%),但其差异无统计学意义(χ~2=0.62、χ~2=0.50,P值均>0.05)。T-SPOT.TB检测的特异性为75.3%(61/81),要低于16KD抗体84.0%(68/81)(χ~2=5.59,P<0.05);也要低于38KD抗体80.2%(65/81)和LAM抗体81.5%(65/81),但差异无统计学意义(χ~2=0.45、χ~2=0.50,P值均>0.05)。菌阳患者的ESAT-6、CFP-10的SFC分别为47.10±34.53和63.02±35.92,要明显高于菌阴肺结核(P<0.05、P<0.01)。重症患者的ESAT-6、CFP-10的SFC分别为60.84±31.76和74.75±33.75,明显高于轻症患者(P<0.001)。通过受试者工作特征曲线(ROC曲线),当EAST-6的SFC取值21.5时最具诊断价值,其灵敏度为74.8%,特异度为94.5%;CFP-10取值19.5时最具诊断价值,灵敏度为77.6%,特异度为91.8%。结论 TSPOT.TB对活动性肺结核的诊断有一定的价值,和其他血清学结核抗体检测相比有一定的优势,但并不十分突出。两种抗原的SFC值与疾病的轻重程度相关,SFC的具体数值有一定的临床价值和意义。

Objective To study the auxiliary diagnostic value of T-SPOT. TB for active tuberculosis. Meth- ods Rapid T-SPOT. TB assay was employed to detect Mycobacterium tuberculosis antigen specific T cells in blood samples from 153 cases with pulmonary tuberculosis （the A group） and 81 cases with non TB pulmonary disease （the B group）, and also the antibody LAM, 16KD and 38KD in the two groups was detected by proteinchips. Results The sensitivity of T-SPOT. TB assay in active pulmonary tuberculosis was 78.4% （ 120/153 ）, and it was significantly higher than 24. 7% of the B group （ 20/81 ） （χ2 = 80. 91, P 〈 0. 001 ）. The sensitivity of T-SPOT. TB assay was higher than that of tuberculosis antibody 16KD [ 10. 5% （χ2 =52. 26, P 〈0. 001 ） 1, but there was no statistical sig- nificance （χ2 = 0. 62, χ2 =0. 50, P 〉 0. 05 ） compared with antibody 38KD （54. 9% ） and antibody LAM （58.8%）. The specificity of T-SPOT. TB assay was 75.3% （61/81） , lower than antibody 16KD E 84. 0% （ χ2 = 5.59, P 〈 0. 05 ） ] , but there was no statistical significance （ χ2 = 0.45, χ2 = 0. 50, P 〉 0. 05 ） compared with anti- body 38KD （80. 2% ） and antibody LAM （81.5%）. SFC count of ESAT-6 and CFP-10 in smear and culture positive pulmonary tuberculosis was respectively 47.10± 34. 53 and 63.02± 35.92, and it was significantly higher than that in smear and culture negative pulmonary tuberculosis （P 〈0.05, P 〈0. 01 ）. SFC count of ESAT-6 and CFP-10 in severe patients was respectively 60. 84 ±31.76 and 74. 75 ± 33.75, and it was significantly higher than that in mild patients （P 〈0. 001 ）. When the critical value of SFC count of ESAT-6 by ROC curve was 21.5, the sensitivity was 74. 8% , and the specificity was 94. 5%. When the critical value of SFC count of CFP-IO by ROC curve was 19. 5, the sensitivity was 77.6%, and the specificity was 91.8%. Conclusion Compared with serum tuberculosis antibody tests, T-SPOT. TB assay has a certain value in the diagnosis of active tuberculosis. SFC count of ESAT-6 and CFP- 10 is correlated with the severity of the disease, and the specific value of SFC count has certain clinical significance.