结核感染T细胞斑点试验的临床应用价值探讨

Clinical application value of T-spot assay.tubercle bacillus

目的探讨结核感染T细胞斑点试验(T-spot assay.tubercle bacillus,T-SPOT.TB)在肺结核诊断中的临床意义及斑点形成细胞数的参考价值。方法应用结核感染T细胞斑点试验(T-SPOT.TB)检测方法对210例2017年1~12月期间入住某院且临床已诊断肺结核病例(结核病组)和非结核疾病的其他肺部疾病病例(非结核疾病组)66例血液标本进行检测并分析结果。结果以临床诊断为标准,T-SPOT.TB试验敏感度为84.29%(177/210);特异度为78.79%(52/66)。肺结核组斑点形成细胞数(SFC)为(44.80±61.51)(结核特异的混合抗原A,ESAT-6抗原)和(54.97±80.59)(结核特异的混合抗原B,CFP-10抗原);非结核疾病的其他肺部疾病组斑点形成细胞数为(2.71±3.77)(ESAT-6抗原)和(2.55±4.05)(CFP-10抗原),两组结果差异有统计学意义[t=-5.55,P=0.000(A)及t=-5.28,P=0.005(B)]。T-SPOT.TB阳性的肺结核组SFCs为(52.70±63.97)(ESAT-6抗原)和(64.64±84.34)(CFP-10抗原),而T-SPOT.TB阳性的其他肺部疾病组SFCs为(7.00±5.35)(ESAT-6抗原)和(7.71±6.12)(CFP-10抗原),两组差异有统计学意义[t=-2.666,P=0.001(A)及t=-2.519,P=0.000(B)]。T-SPOT.TB阴性的肺结核组SFCs为(2.42±2.00)(ESAT-6抗原),而其他肺部疾病组SFCs为(1.56±2.10)(ESAT-6抗原),两组差异无统计学意义[t=-1.888,P=0.888(A)]。结论 T-SPOT.TB斑点形成数在肺结核诊断中有一定的参考价值,在临床实践中应高度重视斑点形成细胞数高值的受检者,尽早采取防治措施。

Objective To evaluate the clinical application value of T-spot assay.tubercle bacillus(T-SPOT.TB) in pulmonary tuberculosis and the reference value of spot-forming cells(SFCs).Methods T-SPOT.TB test was applied to detect the blood samples from 210 patients admitted to a hospital in 2017 who had been clinically diagnosed with tuberculosis(tuberculosis group) and 66 non-tuberculosis patients but with other lung diseases(non-tuberculosis group).And then the results were analyzed.Results With clinical diagnosis as a standard,the sensitivity(Se) and the specificity(Sp)were 84.29%(177/210) and 78.79%(52/66) respectively by T-SPOT.TB test.Average number of spot-forming-cells(SFCs) on tuberculosis patients were(44.80±61.51)(ESAT-6)and(54.97±80.59)(CFP-10);while SFCs on non-tuberculosis patients were(2.71±3.77)(ESAT-6)and(2.55±4.05)(CFP-10),the differences between two groups were statistically significant[t=-5.55,P=0.000(A)and t=-5.28,P=0.005(B)].The SFCs of positive tuberculosis group were(52.70±63.97)(ESAT-6)and(64.64±84.34)(CFP-10),while the SFCs of positive non-tuberculosis group were(7.00±5.35)(ESAT-6)and(7.71±6.12)(CFP-10),the differences between two groups were statistically significant[t=-2.666,P=0.001(A)及t=-2.519,P=0.000(B)].The SFCs of negative tuberculosis group were(2.42±2.00)(ESAT-6),and they were were(1.56±2.10)(ESAT-6) in negative non-tuberculosis group,the differences between two groups were not statistically significant[t=-1.888,P=0.888(A)].Conclusion The number of spot-forming cells has a certain reference value on the diagnosis of pulmonary tuberculosis.In practice,those patients with high spot-forming cells need to be paid more attention to,and early measures should be taken.