结核病T细胞中结核特异性抗原和植物血凝素比值在活动性结核与潜伏结核鉴别诊断中的应用价值

Differential Value of T-SPOT.TB TBAg/PHA Ratio in the Diagnosis of Active Tuberculosis and Latent Tuberculosis

目的分析结核病T细胞中结核特异性抗原(TBAg)和植物血凝素(PHA)比值(TBAg/PHA)在活动性结核与潜伏结核鉴别诊断中的应用价值。方法选取2016年9月—2018年9月期间在粤北第二人民医院就诊疑似肺结核患者,进行结核感染T细胞检测(T-SPOT.TB)阳性的患者673例进行研究,其中诊断为活动性结核(ATB)的患者351例,潜伏性结核感染(LTBI)的患者322例,结合临床表现、病原学检测与影像学检查,对比这两组人群中T-SPOT.TB斑点数[1],从而确定TBAg/PHA界值,分析T-SPOT.TB中TBAg/PHA比值在活动性结核和潜伏结核鉴别诊断中的应用价值。结果潜伏性结核感染TBAg/PHA<0.3为T-SPOT阳性(低值),活动性结核TBAg/PHA>0.3为T-SPOT阳性(高值)。结论TBAg/PHA最佳的比值界值0.3可有效区分ATB与LTBI,诊断准确率更高,具有更高的应用价值,值得推广和进一步加强研究。

Objective To analyze the value of TBAg/PHA ratio in the differential diagnosis of active tuberculosis and latent tu? berculosis in T-SPOT.TB. Methods 673 patients who tested positive for lung T-SPOT.TB in the hospital from September,2016 to September,2018 were collected,including 351 patients with active tuberculosis(ATB)and 322 patients with latent tuberculosis infection(LTBI). Clinical manifestation,pathogenic and imaging tests were used to compare the number of T-SPOT.TB spots in the two groups in order to determine the TBAg/PHA boundary value and to analyze the value of TBAG/PHA ratio in T-SPOT.TB differential diagnosis of active nodules and latent nodules. Results TBAg/PHA<0.3 of latent tuberculosis infection was T-SPOT positive(low value),TBAg/PHA>0.3 of active tuberculosis infection active was T-SPOT positive(high value). Conclusion TBAg/PHA optimal ratio boundary value 0.3 can effectively distinguish ATB and LTBI,detect ATB patients early and effectively manage LTBI patients, and can effectively and accurately diagnose active nodules. It has very high application value,so it is worth further promotion and re? search.