结核感染T细胞斑点试验对结核感染诊断价值的研究

Study on diagnostic value of enzyme-linked immune-spot assay(TSPOT.TB) in Mycobacterium tuberculosis infection

目的探讨结核感染T细胞斑点试验(TSPOT.TB)对结核感染诊断的价值。方法对2015年8月至2016年10月在奎屯医院门诊及住院收治的211例疑似结核病患者进行结核感染T细胞斑点试验,按就诊最终诊断分为MTB感染组和对照组,并与血清抗结核抗体(TB-Ab)、荧光染色抗酸杆菌镜检结果比较。数据采用SPSS 15.0进行统计分析。结果 TSPOT.TB诊断结核感染的敏感性和特异性为96.7%、92.5%;阳性预测值和阴性预测值为90.7%、97.4%;阳性似然比和阴性似然比为12.9%、0.04%,均优于血清抗结核抗体Ig G、荧光染色抗酸杆菌镜检(P<0.01),MTB感染组ESAT-6、CFP 10阳性率分别为81.4%、72.5%,均高于对照组,联合检测阳性率98.9%,高于单一抗原阳性率(P<0.01)。结论结核感染T细胞斑点试验在MTB感染的筛查,快速早期辅助结核病诊断方面意义重大,值得推广应用。

Objective To explore the diagnostic value of enzyme-linked immune-spot assay（TSPOT.TB） in Mycobacterium tuberculosis（MTB） infection. Methods The TSPOT.TB assay was used in 211 suspected patients with tuberculosis（TB） in the Kuitun Hospital, Yili Kazak Prefecture, Xinjiang from August 2015 to October 2016. According to the final diagnoses, the patients were divided into a MTB infection group and control group. The results of TSPOT.TB assay were compared with the serum anti-tuberculosis antibody（TB-Ab） and fluorescence staining acid-fast bacilli. The data were analyzed by using SPSS 15.0. Results The sensitivity and specificity of TSPOT.TB in the diagnosis of TB infection were96.7% and 92.5% respectively; the positive predictive value and negative predictive value were 90.7% and 97.4% re-spectively; the positive likelihood ratio and negative likelihood ratio were 12.9% and 0.04% respectively, which were higher than those of the serum TB-Ab Ig G and fluorescence staining acid-fast bacilli（P〈0.01）. The positive rates of ESAT-6 and CFP-10 in the MTB-infected group were 81.4% and 72.5% respectively, being higher than those in the control group. The combined detection rate was 98.9%, and it was higher than the single antigen positive rate（P〈 0.01）. Conclusion TSPOT.TB has a great significance in the MTB infection screening and rapid early diagnosis of TB, and it is worth of popularization and application.