可疑结核病症状者结核分枝杆菌潜伏感染状况分析

Analysis of latent infection of Mycobacterium tuberculosis of patients with suspected tuberculosis symptoms

目的探讨外周血结核感染T细胞斑点试验(Tuberculosis T cell spot assay,T-SPOT.TB)在可疑结核病症状者诊断与鉴别诊断中的临床应用价值。方法应用广州市结核病防治所海珠分所2018—2019年可疑结核病症状者行T-SPOT.TB检测的实验结果结合临床资料,将病例分成结核病者(A组)、其他肺部疾者(B组)和最后临床诊断为正常或陈旧性肺结核者(C组),应用χ^2检验比较分析各组间以及各组不同性别、年龄组间T-SPOT.TB检测阳性率的差异。结果A组606例、B组104例和C组114例患者纳入分析。结核病患者与非结核病患者(B组+C组)的T-SPOT.TB检测阳性率分别为90.10%和49.08%,差异有统计学意义(χ^2=164.007,P<0.001);按青年(≤44岁)、中年(45~59岁)、老年(≥60岁)年龄组分类分别予以比较,A、B、C 3组间差异均有统计学意义(均P<0.05),但男、女性别间差异均无统计学意义(均P>0.05)。在704例以ESAT6、CFP10分开报告阴阳性的实验结果中,报告双抗原阳性、ESAT6阳性、CFP10阳性和双抗原阴性的病例数分别为497例、55例、23例和129例。结论可疑结核病症状者结核分枝杆菌潜伏感染率高于一般人群(目前全球约为1/4,2000年我国第4次结核病流行病学调查结果为44.5%),而且T-SPOT.TB检测指示结核分枝杆菌潜伏感染存在一定程度的假阴性。

Objective To evaluate the clinical value of tuberculosis T cell spot assay(for short“T-SPOT.TB”)for diagnosis and differential diagnosis of patients with suspected tuberculosis symptoms.Methods The results of T-SPOT.TB and clinical information of cases with suspected tuberculosis symptoms from Haizhu Branch of Guangzhou Tuberculosis Prevention and Control Institute from 2018 to 2019 were collected and sorted.These cases were divided into tuberculosis group(referred to as"Group A"),other lung diseases group(referred to as"Group B"),and healthy group(including normal or old pulmonary tuberculosis,referred to as"Group C")according to the final clinical diagnosis.Statistical analyses between groups,sex and age groups were performed byχ^2 test.Results Cases included in the analysis consisted 606 cases of group A,104 cases of group B,and 114 cases of group C.The positive rates of T-SPOT.TB test for tuberculosis patients and non-tuberculosis patients(involving cases of group B and group C)were 90.10%and 49.08%respectively(χ^2=164.007,P<0.001).It was the same when they were separated to compare according to youth(≤44 years old),middle age(45-59 years old),and old age(≥60 years old)(P<0.05),but there were no statistically significant differences between male and female(all P>0.05).As to 704 test results reported separately of detecting ESAT6 and CFP10,the number of cases with double antigen positive,ESAT6 positive,CFP10 positive,and double antigen negative were 497,55,23,and 129 respectively.Conclusions The rate of latent infection of Mycobacterium tuberculosis(LTBI)of cases with suspected tuberculosis symptoms is higher than that of the general population(about 1/4 currently in the world,44.5%in China in 2000 basing on the fourth national tuberculosis epidemiological survey).There is a certain degree of false negatives by applying T-SPOT.TB to indicate LTBI.