T-SPOT.TB在风湿免疫性疾病患者中筛查结核感染的价值

发布时间：2018-03-11 16:10

本文选题：风湿免疫性疾病　切入点：活动性结核感染　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1、探讨T细胞酶联免疫斑点法(T-SPOT.TB)对风湿免疫性疾病患者合并结核分枝杆菌感染的诊断价值以及评估风湿免疫性疾病患者潜伏性结核感染风险的价值。2、探讨风湿免疫性疾病患者接受免疫抑制治疗前及过程中筛查潜伏性结核感染的优选诊断方案。方法:回顾性分析2015年1月至2016年9月期间于吉林大学第一医院风湿免疫科住院的患者355例,其中有46例风湿免疫性疾病合并结核感染和44例除外结核感染的风湿免疫性疾病患者,对比分析T-SPOT.TB试验与肺CT检查、TB-Ab的诊断结核感染的价值;接受糖皮质激素、生物制剂等免疫抑制治疗的93例患者为免疫抑制组,未接受免疫抑制治疗的262例未非免疫抑制组,两者对比分析接受免疫抑制治疗对风湿免疫性疾病患者感染结核分枝杆菌的影响;将免疫抑制治疗组93例患者按接受免疫抑制治疗时间分为三组,小于等于6个月的为A组,6个月到24个月为B组(含24个月),大于等于25个月的为C组,探讨免疫抑制治疗时间与结核感染及潜伏性结核进展为活动性结核之间的相关性。结果:1、T-SPOT.TB灵敏度为82.61%,与TB-Ab的灵敏度(47.83%)相比有统计学差异(X2=12.267,P=0.001);与肺CT的灵敏度(71.74%)相比无统计学差异(X2=1.543,P=0.214)。2、T-SPOT.TB的阳性预测值、阴性预测值、约登指数、阳性似然比均明显高于TB-Ab和肺CT(均P0.05)。3、免疫抑制组的T-SPOT.TB阳性率、结核感染率分别是37.60%、24.70%,与非免疫抑制组的(21.40%、9.20%)相比较有统计学差异(X2=9.52,P=0.002;X2=14.487,P0.001),免疫抑制组和非免疫抑制组的潜伏性结核感染率分别为7.5%、9.5%,两者无统计学差异(X2=0.34,P=0.56)。4、免疫抑制治疗组,其中A组T-SPOT.TB阳性率为30%,B组阳性率为37.78%,C组阳性率为50%。A、B、C三组结核感染率分别为10%、26.67%、38.89%。A、B、C三组潜伏性结核感染率分别为10%、8.89%、0%。结论:1、T-SPOT.TB在诊断结核感染中的灵敏度和特异度均高于TB-Ab和肺CT。2、长期接受免疫抑制治疗的风湿免疫性疾病患者感染结核及潜伏性结核进展为活动性结核的风险高。3、T-SPOT.TB筛查风湿免疫性疾病患者的LTBI对临床早期诊断和指导用药有着重要价值。
[Abstract]:Objective to investigate the diagnostic value of T-SPOT.TB in patients with rheumatic immune diseases and evaluate the risk of latent tuberculosis infection in patients with rheumatic immune diseases. Methods: a selective diagnostic protocol for screening latent tuberculosis infection in patients with wet immune diseases before and during immunosuppressive therapy. Methods: from January 2015 to September 2016, rheumatic immunity was retrospectively analyzed in the first Hospital of Jilin University. 355 inpatients, Among them, 46 patients with rheumatoid immune diseases complicated with tuberculosis infection and 44 patients with rheumatic immune diseases with the exception of tuberculosis infection, were compared and analyzed the value of T-SPOT.TB test and lung CT examination in the diagnosis of tuberculosis infection, and received glucocorticoid, The 93 patients with immunosuppressive therapy such as biological agents were immunosuppressive group, while 262 patients without immunosuppressive therapy were non-immunosuppressive group. The effect of immunosuppressive therapy on mycobacterium tuberculosis infection in patients with rheumatic immune diseases was compared and 93 patients in immunosuppressive group were divided into three groups according to the time of immunosuppressive therapy. Group A for less than 6 months and group B for 6 to 24 months (including 24 months and greater than 25 months for group C), To investigate the correlation between the time of immunosuppressive therapy and the active tuberculosis of tuberculosis infection and latent TB. Results the sensitivity of T-SPOT.TB was 82.61, which was significantly different from that of TB-Ab (47.83T), and the sensitivity of lung CT was 71.74. There was no statistical difference in the positive predictive value of T-SPOT.TB. Negative predictive value, Yorden index, positive likelihood ratio were significantly higher than those of TB-Ab and lung CT.The T-SPOT.TB positive rate in immunosuppressive group was significantly higher than that in the immunosuppression group. The infection rate of tuberculosis was 37.60,24.70. There was a statistical difference between the non-immunosuppressive group and the non-immunosuppressive group (P < 0.01). The infection rate of latent tuberculosis in the immunosuppression group and the non-immunosuppressive group was 7.59.55.There was no statistical difference between the two groups, and there was no statistical difference between the two groups, and there was no statistical difference between the two groups, and in the immunosuppressive treatment group, the infection rate of latent tuberculosis was 7.59.55.There was no statistical difference between the two groups, and the immunosuppressive group was 0.560.561.The infection rate of latent tuberculosis was 7.59.5in the immunosuppressive group and non-immunosuppressive group, respectively. The positive rate of T-SPOT.TB in group A was 30 and the positive rate in group C was 37.780.The positive rate of TB in group C was 50. Agnb BU C was 1026.677.The infection rate of latent tuberculosis in group A was 108.890.Conclusion the sensitivity and specificity of T-SPOT.TB in diagnosing tuberculosis infection are higher than those of TB-Ab. High risk of tuberculosis infection and latent tuberculosis progression to active tuberculosis in patients with rheumatic immune diseases who received immunosuppressive therapy for a long period of time. 3T-SPOT.TB screening for LTBI in patients with rheumatic immune diseases for early clinical diagnosis and guidance. Medicine has important value.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2;R52

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