结核特异性QFT⁃TB在结核患者不同类型标本中的检测价值

目的比较结核诊断实验室特异性细胞免疫IGRAs体外检测QuantiFERON-TB Gold(QFTTB)方法对肺结核、肺外结核和特殊人群样本的诊断效能,为临床诊疗提供依据。方法收集2023年1-7月实验室检查细菌学检测结核患者546例[痰涂片阳性(AFB+)146例,痰涂片阳性(AFB-)247例],分子生物学阳性结核患者117例(Xpert 69例,TB-DNA 48例),病理组织学阳性患者36例。肺外结核患者72例,特殊样本胸水276例,腹水25例。采用QFT-TB方法进行检测,利用χ^(2)检验进行组间比较,对比其阳性率和符合率的方法学评估。结果肺结核、肺外结核和结核密切接触者QFT-TB检测阳性率为83.69%、69.44%和32.41%。在AFB+、GeneXpert、TB-DNA和病理证实确诊为结核病患者QFT-TB方法的符合率为91.09%、88.40%、81.25%和72.22%。结核性胸膜炎患者胸水检测阳性率为60.50%、腹水阳性率为44.00%。结论QFT-TB检测在辅助诊断肺结核有较好价值,对于基于胸、腹水的检测用于肺外结核的诊断有一定的参考意义。

痰涂片、TB⁃DNA、Gene Xpert MTB/RIF在肺结核中的阳性检出率对比

目的探析对比痰涂片、结核分枝杆菌脱氧核糖核酸(TB⁃DNA)检测、Gene Xpert系统结核分枝杆菌/利福平耐药实时荧光定量基因扩增检测技术(Gene Xpert MTB/RIF)在肺结核中的阳性检出率。方法选择梅州市人民医院感染科2019年1月至2021年12月收治的391例肺结核患者作为观察组,选择同期接受检查的463名健康体检者作为对照组。所有研究对象均接受痰涂片、TB⁃DNA、Gene Xpert MTB/RIF诊断。以结核培养结果为金标准,对比不同诊断技术对非肺结核、肺结核的诊断结果;对比不同诊断技术对肺结核的诊断价值;采用受试者工作特征(ROC)曲线分析痰涂片、TB⁃DNA、Gene Xpert MTB/RIF在肺结核中的阳性检出率。结果不同诊断技术对肺结核的阳性检出率比较差异有统计学意义(P<0.05),且Gene Xpert MTB/RIF阳性检出率(51.52%)高于TB⁃DNA(37.59%)、痰涂片(22.48%)。ROC曲线结果显示,Gene Xpert MTB/RIF诊断肺结核的AUC为0.937(0.919~0.956),高于其余诊断策略(P<0.05);其敏感度、特异度分别为95.9%、91.6%。结论相较于痰涂片、TB⁃DNA诊断技术,Gene Xpert MTB/RIF对于肺结核的阳性检出率更高,与结核培养结果金标准一致性更高。Gene Xpert MTB/RIF诊断效能更优,应根据实践情况灵活选择诊断技术。

Diagnostic Evaluation of GeneXpert MTB/RIF Assay for the Detection of Rifampicin Resistant Mycobacterium tuberculosis among Pulmonary Tuberculosis Patients in Bangladesh

Background: The emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug- resistant tuberculosis (XDR-TB) has highlighted the need for early accurate detection and drug susceptibility. Objective: The purpose of the present study was to evaluate the accuracy of GeneX-pert MTB/RIF assay for the detection of Mycobacterium tuberculosis and rifampicin resistance. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical College, Dhaka and National Institute of Chest Disease & Hospital (NIDCH), Dhaka during the period of January 2014 to December 2014 for a period of 1 (one) year. Sputum samples from suspected MDR-TB patients were collected by purposive sampling technique from OPD of Sir Salimullah Medical College (SSMC) and NIDCH. Microscopy, liquid culture in liquid MGIT 960 media and GeneXpert MTB/RIF were done for MTB diagnosis and detection of rifampicin resistance. MGIT 960 media were also used for determination of drug resistance. Result: Liquid culture yielded higher growth (68%) from 100 samples while GeneXpert MTB assay showed similar result (67% positive and 33% negative). Drug susceptibility test in MGIT 960 media showed that out of 68 positive cases Rifampicin resistant cases were 15 (22.05%) whereas GeneXpert MTB assay detected 14 (20.89%) were Rifampicin resistant out of 67 MTB positive samples. When compared to liquid culture the calculated sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of GeneXpert MTB were 98.52%, 100%, 96.96%, 100% and 99%. Conclusion: GeneXpert MTB/RIF assay is high detection rate of pulmonary tuberculosis and multidrug resistant tuberculosis.

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Purpose: To evaluate diagnostic accuracy of IS6110 insertion genes, hsp65, and Xpert MTB/RIF for rapid diagnosis of pulmonary tuberculosis. Methods: Sixty patients, medically reported HIV negative, clinically suspected of having pulmonary tuberculosis, were included in this study, and consented before enrolment. Sputum samples were gathered once, and tested by smear for Acid Fast Bacilli (AFB). Cultured in the Loewenstein-Jensen (LJ) medium for M. tuberculosis growth, M. tuberculosis DNA was detected by conventional PCR targeting IS6110, and hsp65 genes using specific primers, and automated nested real-time PCR targeting rpoB gene. Sensitivity, specificity and diagnostic accuracy were calculated for each method compared to culture. Results: Compared with culture as reference method, smear, IS6110, hsp65, and Xpert MTB/RIF had sensitivity 77.14%, 100%, 100%, and 100%, specificity 92%, 96%, 96%, and 96.97%, and diagnostic accuracy 83.33%, 98.33%, 98.33% and 98.21% respectively. Molecular diagnostic methods had the highest diagnostic accuracy, whereas smear had the lowest. No statistical significance, (p value > 0.05) was detected between the patients’ demographic data and the presence or absence of TB infection. Conclusion: The diagnostic accuracy that we got from the molecular methods, confirmed the diagnostic value of molecular detection of M. tuberculosis in pulmonary cases, supporting the application of automated and conventional PCR in rapid analysis. Smear could be more efficient when used for treatment monitoring. Combination between one-molecular techniques with smear as a routine method could be valid for rapid diagnosis of TB.

Performance of Loop-Mediated Isothermal Amplification (LAMP)-Lateral Flow Detection and Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis

Background: Due to the limitations of diagnosis by Xpert MTB/RIF assay, WHO suggests Loop—Mediated Isothermal Amplification (TB-LAMP) instead of sputum-smear microscopy for pulmonary TB diagnosis in patients. Dr. Thongchai Kaewphinit et al. invented a fast TB detection kit called TB d-tect (LAMP-LFD assay). There was no clinical trial to estimate the performance of TB d-tect. Objective: This study was aimed to find the performance of LFD assay and Xpert MTB/RIF ultra for pulmonary TB. Material and methods: A cross-sectional study was conducted. Suggestive pulmonary TB patients were enrolled from June 2020-28 February 2021. Respiratory specimens were collected from each patient and sent for AFB smear, LAMP-LFD assay, Xpert MTB/RIF ultra and culture TB. Result: 139 patients with suspected pulmonary TB were enrolled. 51% of patients were diagnosed with pulmonary tuberculosis. Based on culture TB as a gold standard, the sensitivity and specificity of LAMP-LFD assay were 85.4% (95% CI: 70.8% - 94.4%) and 87.8% (95% CI: 79.6 - 93.5), respectively. The sensitivity and specificity of Xpert MTB/RIF ultra were 95.1% (95% CI: 83.5% - 99.4%) and 74.5% (95% CI: 64.7 - 82.8), respectively. According to ROC curve, it was found that the areas under the curve of LAMP-LFD assay and Xpert MTB/RIF ultra were 0.866 and 0.848, respectively (p = 0.546). Conclusion: The diagnostic sensitivity and specificity of LAMP-LFD assay appeared to be comparable to those of Xpert MTB/RIF ultra. LAMP-LFD assay could be used in resource limiting laboratory.

痰TB-RNA在继发性活动性肺结核患者中的应用

目的 比较结核分枝杆菌RNA(TB-RNA)等四种检测方法在继发性活动性肺结核患者中的检出率,探讨TB-RNA在继发性活动性肺结核中的应用价值。方法 选取2022年11月至2024年5月在广西胸科医院结核科住院的继发性活动性肺结核患者283例。留取合格的痰标本,分别进行涂片、固体培养、TB-RNA和Xpert检测。剔除检测结果不全者后,最终获得资料完整的病例245例。将TB-RNA检测灵敏度与涂片、固体培养和Xpert结果进行比较分析;使用Kappa检验评估涂片、TB-RNA、Xpert和固体培养结果的一致性。结果 以临床诊断为参考标准,TB-RNA灵敏度(55.10%)高于培养(47.76%)和涂片(36.73%),其差异有统计学意义(P<0.05);但低于Xpert(74.69%),此差异也有统计学意义(P<0.05)。TB-RNA的准确率为84.49%,高于涂片(75.92%)和Xpert(68.98%)。Kappa一致性分析结果显示,TB-RNA与培养结果的一致性最高(0.691),其次为涂片(0.513)和Xpert(0.393)。结论 TB-RNA的检测灵敏度相较于传统方法有一定优势,尽管现阶段尚不能完全取代结核分枝杆菌分离培养,但它具有独特的技术特点和优势,可用于继发性活动性肺结核患者的辅助诊断。

Xpert MTB/RIF和T-SPOT.TB对涂阴肺结核诊断价值的评估

目的 评估并比较Xpert MTB/RIF和T-SPOT.TB对涂阴肺结核的诊断价值。方法 收集2014年12月至2015年12月天津市海河医院门诊和住院的呼吸疾病患者208例,分为结核组125例和对照组83例,同时对其痰液样本行涂片镜检、液体快速培养和Xpert MTB/RIF检测,对其血液样本行T-SPOT.TB试验。结果 Xpert MTB/RIF诊断涂阴肺结核的敏感性、特异性、ROC曲线下面积（AUC）及优势比（odds ratio,OR）分别为56.5%（95%CI：45.8%~66.8%）、98.8%（95%CI：93.5%~100.0%）、0.777（95%CI：0.708~0.836）及106.60（χ^2=62.87,P〈0.01）;T-SPOT.TB诊断涂阴肺结核的敏感性、特异性、AUC及OR值分别为83.7%（95%CI：74.5%~90.5%）、62.7%（95%CI：51.3%~73.0%）、0.732（95%CI：0.660~0.796）及8.61（χ^2=39.44,P〈0.01）;两者敏感性（χ^2=18.58）和特异性（χ^2=28.03）的差异有统计学意义（P〈0.05）,AUC的差异无统计学意义（Z=1.235,P〉0.05）;Xpert MTB/RIF阴性的涂阴肺结核患者T-SPOT.TB阳性率为70.0%。结论 Xpert MTB/RIF和T-SPOT.TB均有助于早期、快速、准确地辅助诊断肺结核,T-SPOT.TB可以作为Xpert MTB/RIF的后续试验辅助诊断Xpert MTB/RIF阴性的涂阴肺结核。

T-SPOT.TB在肺结核合并糖尿病患者诊断中的价值

目的探讨结核杆菌T细胞斑点实验(T-SPOT.TB)对肺结核合并糖尿病患者的诊断价值。方法以临床诊断为金标准,比较T-SPOT.TB、抗酸杆菌涂片法、TB-DNA法及结核菌素皮试(TST)检测41例肺结核合并糖尿病的诊断灵敏度。结果在对41例临床确诊为肺结核合并糖尿病患者中,T-SPOT.TB诊断灵敏度(95.12%)显著高于抗酸杆菌涂片(31.70%)、TB-DNA(43.90%)及TST(68.29%)(P<0.05)。T-SPOT.TB对菌阳肺结核确诊率(95.45%)与菌阴肺结核确诊率(94.74%)比较差异无统计学意义(P>0.05)。结论 T-SPOT.TB诊断肺结核合并糖尿病具有良好的灵敏度,且对其诊断与鉴别具有重要临床价值。

涂阳肺结核患者TB-DNA定量、γ干扰素释放试验、结核抗体检测的价值

目的探讨肺结核(TB)-DNA定量、γ干扰素释放试验(T-SPOT.TB)、结核抗体检测对活动性肺结核辅助诊断的价值。方法回顾性分析2013年7月至2014年6月入院确诊为肺结核且抗酸杆菌痰涂片阳性51例患者的TB-DNA定量、TSPOT.TB、结核抗体检测指标。结果 T-SPOT.TB检测阳性率为90.2%,灵敏度最高;其次为TB-DNA定量,阳性率为74.5%;结核抗体检测阳性率仅为37.3%,灵敏度最低。结论 T-SPOT.TB检测不受标本采集的影响,灵敏度高,对活动性肺结核的辅助诊断具有较高价值。

血清ADA水平和T-spot.TB联合检测在肺结核诊断中的应用

目的探讨分析肺结核诊断中联合应用血清腺苷脱氨酶(ADA)以及结核感染T细胞斑点试验(T-spot.TB)检测的临床价值。方法随机选取该院2015年1月—2016年10月收治的140例拟诊为肺结核患者分为治疗组(肺结核患者,70例)和对照组(非肺结核健康者,70例),对比两组ADA水平以及T-spot.TB阳性率以及联合检测的灵敏度、特异性等情况。结果治疗组患者ADA水平显著高于对照组(P<0.05),治疗组患者ADA检测阳性率(55.7%)、T-spot.TB阳性率(88.6%)显著高于对照组(15.7%、17.1%)。血清ADA、T-spot.TB平行联合检测可提高对肺结核诊断灵敏度(91.6%)及阴性预测值(93.6%),但阳性预测值、特异性明显下降,系列联合检测可提高对肺结核诊断的特异性(94.9%)、阳性预测值(86.2%),但是灵敏度、阴性预测值较低。结论肺结核患者采用血清ADA水平以及T-spot.TB斑点数联合检测的临床价值较高,值得推荐。

T-SPOT.TB检验在活动性肺结核患者中的临床意义

目的通过测定活动性肺结核患者血浆中T-SPOT.TB检验结果,探讨其临床价值。方法对36例活动性肺结核患者同期进行T-SPOT.TB检验及PPD试验。结果活动性肺结核患者T-SPOT.TB阳性率为94.4%,高于PPD试验;并且T-SPOT.TB检验的阳性检测率高于PPD试验。结论 T-SPOT.TB检验对活动性肺结核患者诊断具有较高的临床价值,可以达到早期检测结核感染的目的。

T—spot．TB、TB—Ab和ESR联合检测在菌阴及肺外结核诊断中的应用

目的：评价T-spot.TB、TB-Ab和ESR三种方法联合检测在菌阴及肺外结核诊断中的临床应用价值。方法：应用T-spot.TB 、TB-Ab和 ESR三种方法分别对确诊组180例肺结核和85例非肺结核疾病患者进行检测。结果：T-spot.TB 、TB-Ab和 ESR在肺结核检测中的敏感性分别为94.44%、51.11%、47.22%。在对照组其特异性分别为96.47%、65.88%、57.64%。T- spot.TB在菌阴肺结核中的阳性率为94.89%。结论：T- spot.TB在肺结核诊断中具有很高的敏感性，三种方法联合检测可极大的减少结核的漏检率，可作为结核病早期诊断的有效辅助检查手段。

血清ADA水平和T-spot.TB联合检测在肺结核诊断中的应用

目的:联合应用血清腺苷脱氨酶(ADA)水平检测和结核感染T细胞斑点试验(T-spot.TB),探讨其对肺结核诊断的临床价值。方法:选取本院拟诊为肺结核患者159例,分为肺结核组(n=91)和非肺结核组(n=68),随机选取健康体检者80名作为健康对照组,检测各组受试者血清ADA水平和T-spot.TB斑点数,比较各组ADA水平和T-spot.TB的阳性率及其对肺结核诊断的灵敏性与特异性。结果:肺结核组、非肺结核组和健康对照组受试者血清ADA水平分别为(22.10±6.60)、(16.90±6.35)和(8.70±5.98)U·L^(-1),肺结核组患者血清ADA水平明显高于非肺结核组和健康对照组(P<0.05)。血清ADA水平对肺结核诊断的阳性率为56.0%,T-spot.TB对肺结核诊断的阳性率为87.9%。采用平行联合试验,检测灵敏性为91.2%;采用系列联合试验,特异性为94.6%。结论:联合检测血清ADA水平及T-spot.TB斑点数能够显著提高肺结核临床诊断。

荧光监测TB-DNA在呼吸系统疾病中的应用价值研究

目的:探讨肺泡灌洗液与胸腔积液中TB-DNA检查在呼吸系统疾病中的应用价值。方法:选取肺部影像学异常患者113例,分别行肺泡灌洗液TB-DNA及痰找抗酸杆菌监测;再选取胸腔积液患者90例,同时行胸腔积液ADA及胸腔积液TB-DNA监测。结果:肺部影像学异常患者113例中,明确诊断肺结核27例,TB-DNA灵敏度为92.6%,痰找抗酸杆菌灵敏度为63.%,差异有统计学意义(P<0.05);非肺结核患者中无1例TB-DNA增高,特异度达93.0%。胸腔积液患者90例中,结核性胸膜炎29例,胸腔积液ADA增高5例,仅1例胸腔积液TB-DNA增高。结论:分析荧光定量PCR检测TB-DNA是临床病原菌检测的一种具有高灵敏度、高准确性、高特异度、定量范围宽、操作简单、快速安全、污染最少的可靠的DNA体外扩增技术,对临床辅助诊断肺结核具有较高的实用价值。

T-SPOT.TB,TB-Ab和TB-DNA在肺结核与非结核分枝杆菌肺病鉴别诊断中的价值研究

目的探讨结核感染T淋巴细胞酶联免疫斑点试验(T-SPOT.TB),结核抗体(TB-Ab)和结核分枝杆菌脱氧核糖核酸(TB-DNA)在肺结核与非结核分枝杆菌肺病鉴别诊断中的价值。方法回顾南京市胸科医院2013年3月~2017年4月收治的肺结核病人140例,非结核分枝杆菌肺病患者39例。两组患者均抽血做T-SPOT.TB,TB-Ab(胶体金法和蛋白芯片法)检测,培养阳性的标本同时做TB-DNA检测。统计四种方法的敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、阴性似然比、阳性似然比、诊断符合率和约登指数。结果 T-SPOT.TB敏感度、诊断符合率显著高于TBAb和TB-DNA(χ~2=6.91~87.46,P<0.01)。T-SPOT.TB特异度显著高于TB-Ab(χ~2=13.18~24.98,P<0.01),而与TB-DNA差异无统计学意义(Fisher’s Exact Test,P=0.62>0.05)。结论 T-SPOT.TB检测在肺结核与非结核分枝杆菌肺病鉴别诊断中有很高的敏感度、特异度和诊断符合率,对两种疾病的鉴别诊断有很大价值。

合并糖尿病对肺结核患者T-SPOT.TB阳性率的影响

目的探讨合并糖尿病对肺结核患者T-SPOT.TB检查结果的影响。方法选取2016年6月至2017年7月于河南省胸科医院就诊的212例肺结核患者,将103例肺结核合并糖尿病患者纳入试验组,109例单纯肺结核患者纳入对照组,所有患者均行T-SPOT.TB检测,比较两组T-SPOT.TB阳性率。结果试验组T-SPOT.TB检测阳性率为59.2%,低于对照组的82.6%,差异有统计学意义(P<0.05)。结论合并糖尿病可影响T-SPOT.TB检测的阳性率。

痰涂片抗酸染色、结核抗体试验、荧光PCR、T-SPOT.TB在肺结核诊断中的临床意义

目的比较痰涂片抗酸染色、结核抗体试验、荧光PCR和结核感染T细胞斑点试验在肺结核诊断中的价值。方法 96例经肺结核诊断和治疗指南标准确诊为肺结核患者设为实验组,56例其他肺部疾病(非肺结核)患者设为对照组,用上述四种方法同时进行检测。计算每种方法的灵敏度、特异度、准确性,并进行四种检测方法之间的配对χ~2检验。结果痰涂片抗酸染色、结核抗体试验、荧光PCR、T-SPOT.TB检测的灵敏度分别为11.46%、44.80%、38.54%和93.75%,特异度分别为98.96%、82.14%、94.64%、91.10%,准确性分别为43.42%、58.55%、59.21%、92.76%,四种方法两两之间比较差异均有统计学意义。结论每种方法各有优缺点,综合评价T-SPOT.TB检测方法优于其他三种方法。工作中,应多种检测方法联合使用,以便对肺结核做出正确的诊断。

肺泡灌洗液TB-SAT快速诊断涂阴肺结核价值的研究

目的探究肺泡灌洗液结核分枝杆菌RNA恒温扩增荧光实时检测技术(TB-SAT)诊断涂阴肺结核诊断的价值。方法选取2022年1月至7月江西省胸科医院收治的60例疑似肺结核患者,将综合诊断结果(符合肺结核基层诊疗指南)设为金标准,进行肺泡灌洗液TB-SAT,分析价值。结果60例患者中,46例患者诊断为肺结核,剩余14例为其他疾病。在46例经金标准诊断为肺结核的患者中,支气管肺泡灌洗液(BALF)抗酸染色诊断9例为肺结核患者;BALF结核菌培养诊断14例为肺结核患者;BALF聚合酶链式反应(PCR)检测诊断21例为肺结核患者;BALF TB-SAT诊断30例为肺结核患者。BALF抗酸染色诊断结果:敏感度为19.57%(9/46)、特异度为57.14%(8/14)、准确度为28.33%(17/60);BALF结核菌培养诊断结果:敏感度为30.43%(14/46)、特异度为78.57%(11/14)、准确度为41.67%(25/60);BALF PCR诊断结果:敏感度为45.65%(21/46)、特异度为64.29%(9/14)、准确度为50.00%(30/60);BALF TB-SAT诊断结果:敏感度为65.22%(30/46)、特异度为92.86%(13/14)、准确度为71.67%(43/60)。BALF TB-SAT诊断结果敏感度、准确度高于其他检测方法,差异有统计学意义(P<0.05);不同检测方法的特异度比较,差异无统计学意义(P>0.05)。结论诊断涂阴肺结核患者时,利用肺泡灌洗液TB-SAT具有较高价值,临床效果显著。

Association of TNF-α-238G/A and 308 G/A Gene Polymorphisms with Pulmonary Tuberculosis among Patients with Coal Worker’s Pneumoconiosis

Objectives Tumor necrosis factor-α （TNF-α） may play an important role in host＇s immune response to mycobacterium tuberculosis （M. tuberculosis） infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis （TB） among patients with coal worker＇s pneumoconiosis （CWP）. Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism （PCR-RFLP）. Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher＇s exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls （2,2=5.44, P=-0.07）. But difference in frequency of the TNF-α-308 A allele was identified between them （2,2-5.14, P=0.02）. No significant difference in frequencies of the TNF-α-238 genotype and allele （P=0.23 and P=0.09, respectively） was found between cases and controls either, with combined （GG and AA） OR of 3.96 （95% confidence interval of 1.30-12.09） at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 （95% CI of 1.06-3.71） for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index （OR=4.92）, as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.

T-SPOT.TB在涂阴肺结核中的快速诊断价值

目的评价结核感染T细胞试验（T-SPOT.TB）在涂阴肺结核病诊断上的价值。方法利用T-SPOT.TB、TBDNA、TB-DOT 3种结核病诊断方法对112例确诊涂阴肺结核病患者和60例非结核病对照者分别进行检测。结果 T-SPOT.TB试验检测灵敏度为88.3%,TB-DNA、TB-DOT的灵敏度依次为25.9%、58.9%,与T-SPOT.TB试验相比,差异均有统计学意义（χ^2=86.6,P〈0.05;χ^2=23.3,P〈0.05）;T-SPOT.TB试验特异度为96.7%,显著高于TB-DOT（78.3%）,差异有统计学意义（χ^2=9.22,P〈0.05）。结论 T-SPOT.TB对涂阴肺结核病的敏感性和特异性都有明显的优势,可以作为涂阴肺结核病早期诊断的一种辅助检查手段,具快速准确的诊断价值。