T-SPOT.TB对含RD1的分枝杆菌皮肤感染的诊断、疗效评估的价值研究

发布时间：2018-04-24 08:01

本文选题：分枝杆菌感染 + 皮肤　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:探讨结核感染T细胞检测(T-SPOT.TB)在含RD1(Region of Difference 1)的分枝杆菌(包括结核分枝杆菌及含RD1的非结核分枝杆菌)皮肤感染中诊断和疗效评估的价值。方法:前瞻性地研究2015年7月至2017年1月在本院诊治的临床及组织病理学检查均疑似皮肤结核或非结核分枝杆菌感染的患者,排除其他脏器结核病的患者(包括现症及既往感染),予于治疗前行T-SPOT.TB检测。对纳入的患者的临床表现、实验室检查、诊断、治疗方案、疗效等进行收集和分析。根据最终诊断将纳入患者分为含RD1分枝杆菌皮肤感染组、其他诊断组(包括非RD1分枝杆菌皮肤感染、真菌感染等)。含RD1分枝杆菌皮肤感染的患者予抗分枝杆菌治疗3月后再次行T-SPOT.TB检查。分析T-SPOT.TB在含RD1的分枝杆菌皮肤感染中的诊断价值及判断疗效的价值。结果:共纳入45例临床及病理均疑似的患者,其中含RD1分枝杆菌皮肤感染组35例,其他诊断组10例。T-SPOT.TB在诊断含RD1的分枝杆菌皮肤感染的敏感度、特异度、阳性预测值、阴性预测值分别为:85.7%、90.0%、96.8%、64.3%,其中T-SPOT.TB在诊断皮肤结核及含RD1非结核分枝杆菌(NTM)皮肤感染中的敏感度分别为100%、70.6%(P=0.013)。T-SPOT.TB的中位斑点形成细胞数(SFCs)在皮肤结核、含RD1的NTM皮肤感染及其他诊断的患者中分别为26.0、14.0和0(P=0.000)。确诊含RD1的分枝杆菌皮肤感染的患者治疗后T-SPOT.TB的阳性率从 88.6%下降为 46.2%(P=0.000),中位 SFCs 从 16.0 降至 5.0(P=0.000)。结论:T-SPOT.TB在含RD1的分枝杆菌皮肤感染的诊断中有较好的诊断效能,特别是在皮肤结核中敏感度高,结合临床、病理可协助皮肤分枝杆菌病的早期诊断。T-SPOT.TB的阳性率、SFCs在含RD1的分枝杆菌皮肤感染治疗后下降,可协助判断疗效。
[Abstract]:Objective: to investigate the value of T-SPOT.TB in the diagnosis and evaluation of cutaneous infection of Mycobacterium tuberculosis (including Mycobacterium tuberculosis and non-tuberculous bacillus) containing RD1(Region of Difference 1. Methods: a prospective study was conducted on patients suspected of skin tuberculosis or non-mycobacterium tuberculosis in clinical and histopathological examinations from July 2015 to January 2017. Patients excluding other visceral tuberculosis (including present and previous infections) were tested for T-SPOT.TB before treatment. Collect and analyze the clinical manifestation, laboratory examination, diagnosis, treatment plan, curative effect and so on. According to the final diagnosis, the patients will be divided into RD1 containing mycobacterium skin infection group, other diagnostic groups (including non- mycobacterium skin infection, fungal infection, etc.). Patients with skin infection of Mycobacterium RD1 were treated with T-SPOT.TB for 3 months. To analyze the diagnostic value of T-SPOT.TB in mycobacterium skin infection containing RD1 and the value of judging curative effect. Results: a total of 45 clinically and pathologically suspected patients were included, including 35 patients with mycobacterium RD1 skin infection and 10 patients with T-SPOT.TB in other diagnostic groups. The sensitivity, specificity and positive predictive value of T-SPOT.TB in the diagnosis of mycobacterial skin infection with RD1 were analyzed. The negative predictive values were 90.0 and 96.84.3.The sensitivity of T-SPOT.TB in the diagnosis of skin tuberculosis and skin infection containing RD1 non-tuberculous mycobacterium was 100% 70.6%, respectively. The median number of spot forming cells (SFCs) of T-SPOT.TB was 100%. The number of patients with NTM skin infection and other diagnoses with RD1 was 26.0V 14.0 and 0.000g, respectively. After treatment, the positive rate of T-SPOT.TB decreased from 88.6% to 46.2%, and the median SFCs decreased from 16.0 to 5.0%. ConclusionTwo T-SPOT.TB is effective in the diagnosis of mycobacterium skin infection with RD1, especially in skin tuberculosis. Pathology can assist in the early diagnosis of mycodermosis. The positive rate of T-SPOT.TB and the decrease of SFCs after the treatment of mycobacterial skin infection with RD1 may help to judge the curative effect.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R754

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