T-SPOT.TB在肾透析患者结核潜伏感染中的应用价值

The application value of T-SPOT.TB in latent infection of tuberculosis in renal dialysis patients

目的探讨结核菌素皮肤试验(tuberculin skin test,TST)和结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)在诊断肾透析患者结核分枝杆菌潜伏感染(latent tuberculous infection,LTBI)中的应用价值。方法选取2018年1月至2018年12月本院收治的60例结核病患者(结核病组)、35例肾透析患者(潜伏感染组)、50名体检健康者(对照组),同时应用TST和T-SPOT.TB对3组进行检测,计算各组TST和T-SPOT.TB阳性率,比较各组间指标的差异性。结果结核病组、潜伏感染组、对照组TST皮肤硬结平均直径分别为(11.8±3.5)mm、(8.8±5.2)mm和(6.5±5.5)mm,阳性率分别为83.3%、71.4%和44.0%,潜伏组皮肤硬结平均直径显著低于结核病组(P<0.05),与对照组比较差异无统计学意义;潜伏感染组TST阳性率显著高于对照组(P<0.05),与结核组比较差异无统计学意义;T-SPOT.TB阳性率分别为91.7%、28.6%和2.0%,组间T-SPOT.TB阳性率比较差异有均有统计学意义(P<0.05)。结论肾透析患者是结核潜伏感染的高危人群;T-SPOT.TB检测在LTBI诊断中的临床应用价值优于TST,但两种检测方法均不能准确区分结核潜伏感染和活动性肺结核。

Objective To explore the value of tuberculin skin test(TST)and T-SPOT.TB in the diagnosis of mycobacterium tuberculosis latent infection(LTBI)of renal dialysis patients.Methods 60 tuberculosis patients(tuberculosis group),35 renal dialysis patients(latent infection group)and 50 physical healthy subjects(control group)were selected from January 2018 to December 2018 in our hospital.At the same time,TST and TSPOT.TB were used to detect the patients in the three groups,calculated the positive rate of TST and T-SPOT.TB in each group,and compare the difference of indexes between the groups.Results The mean diameter of TST skin scleroma in the three group were(11.8±3.5)mm,(8.8±5.2)mm and(6.5±5.5)mm,The positive rates were 83.3%,71.4%and 44.0%.The mean diameter of skin scleroma in the TB group was significantly smaller than that in the TB group(P<0.05),but there was no significant difference with the control group.The TST positive rate of the latent infection group was significantly higher than that of the control group(P<0.05),and there was no significant difference with the tuberculosis group.The positive rates of T-SPOT.TB were 91.7%,28.6%and 2.0%,and there was significant difference among the three groups.Conclusion Renal dialysis patients are the high-risk group of latent tuberculosis infection.The clinical application value of T-SPOT.TB test in the diagnosis of LTBI is superior to that of TST,but neither method can accurately distinguish latent tuberculosis infection from active tuberculosis.