患者外周血细胞分析和结核抗体检测在诊断肺结核中的临床价值

The clinical value of peripheral blood cell analysis and tuberculosis antibody detection in the diagnosis of pulmonary tuberculosis

目的探讨CD45^(+)CD3^(+)淋巴细胞比例、CD45^(+)CD64^(+)单核细胞比例、CD161^(+)细胞比例和16KD、38KD、CFP-10、ESAT-6、LAM结核抗体检测在结核病诊断中的临床价值。方法应用流式细胞术计数202例初治肺结核患者(结核组)和120例体检健康者(健康组)外周全血CD45^(+)单个核细胞、CD45^(+)CD3^(+)淋巴细胞、CD45^(+)CD64^(+)单核细胞、CD161^(+)细胞,应用蛋白芯片技术定量检测患者血清16KD、38KD、CFP-10、ESAT-6、LAM结核抗体,定量比较两组间各细胞比例和抗体表达水平的差异,并应用诊断性试验评价指标评价其临床诊断性能。结果经秩和检验,CD45^(+)CD3^(+)淋巴细胞、CD45^(+)CD64^(+)单核细胞、CD161^(+)细胞以及由其建立的结核菌感染风险指数(RF)在两组间差异有统计学意义(P<0.001),16KD、LAM抗体水平在两组间差异有统计学意义(P<0.001),38KD、CFP-10、ESAT-6抗体水平在两组间的差异无统计学意义(P>0.05);应用16KD、38KD、CFP10、ESAT-6、LAM、CD45^(+)CD3^(+)%、CD45^(+)CD64^(+)%、CD161^(+)%和RF诊断肺结核的ROC曲线下面积分别为0.748、0.525、0.564、0.535、0.680、0.860、0.834、0.667和0.884,其最佳临界值(cut-off)分别为1.031、1.074、1.075、1.062、1.161、78.480、14.250、34.765和0.469,诊断准确度分别为73.91%、54.04%、61.80%、51.55%、68.94%、64.29%、79.50%、52.80%和81.99%。结论RF、CD45^(+)CD3^(+)%、CD45^(+)CD64^(+)%、16KD结核抗体检测在肺结核临床诊断中具有较高的临床应用价值。

Objective To investigate the clinical value of CD45^(+)CD3^(+)lymphocyte ratio,CD45^(+)CD64^(+)monocyte ratio,CD161^(+)cell ratio and 16 KD,38 KD,CFP-10,ESAT-6 and LAM tuberculosis antibody detection in the diagnosis of tuberculosis.Methods Flow cytometry was used to count the peripheral blood CD45^(+)mononuclear cells,CD45^(+)CD3^(+)lymphocytes,CD45^(+)CD64^(+)monocytes and CD161^(+)cells in 202 newly diagnosed pulmonary tuberculosis patients(tuberculosis group)and 120 healthy people(healthy group).Protein chip technology was used to quantitatively detect the serum TB antibodies of patients with 16 KD,38 KD,CFP-10,ESAT-6 and LAM.The differences in the proportion of cells and the expression level of antibodies between the two groups were quantitatively compared.Diagnostic test evaluation indexes were used to evaluate the clinical diagnostic performance.Results The rank sum test showed that CD45^(+)CD3^(+)lymphocytes,CD45^(+)CD64^(+)monocytes,CD161^(+)cells and the established tuberculosis infection risk index(RF)were significantly different between the two groups(P<0.001).The levels of 16 KD and LAM antibodies were significantly different between the two groups(P<0.001).There was no significant difference in the levels of 38 KD,CFP-10 and ESAT-6 antibodies between the two groups(P>0.05).The areas under the ROC curve for the diagnosis of pulmonary tuberculosis using 16 KD,38 KD,CFP10,ESAT-6,LAM,CD45^(+)CD3^(+)%,CD45^(+)CD64^(+)%,CD161^(+)%and RF were 0.748,0.525,0.564,0.535,0.680,0.860,0.834,0.667 and 0.884.The optimal cut-off values were 1.031,1.074,1.075,1.062,1.161,78.480,14.250,34.765 and0.469,respectively,and the diagnostic accuracy was 73.91%,54.04%,61.80%,51.55%,68.94%,64.29%,79.50%,52.80%and 81.99%,respectively.Conclusion The detection of RF,CD45^(+)CD3^(+)%,CD45^(+)CD64^(+)%and 16 KD tuberculosis antibody has high clinical application value in the clinical diagnosis of pulmonary tuberculosis.