T-SPOT.TB联合细胞因子INF-γ、IL-10等检测在结核病诊断中的应用
发布时间:2018-05-12 22:52
本文选题:结核 + 细胞因子 ; 参考:《中南大学》2013年硕士论文
【摘要】:目的:评价结核感染T细胞斑点试验(T-SPOT.TB)联合血浆细胞因子INF-γ、IL-10等检测对活动性结核病与非活动性结核病的鉴别诊断价值以及结核病中Th1型/Th2型细胞因子变化特点。 方法:前瞻性纳入中南大学湘雅三医院2012年10月至2013年2月疑诊结核感染的住院或门诊患者75例以及24例行健康体检的医务工作者,分别行外周血T-SPOT.TB检测,采集血浆标本冻存以及收集完整的临床资料。在研究终点(2013年5月)对所有纳入对象进行诊断评估,将最终符合入组标准的研究对象,分为三组即活动性结核组(设为A组),非活动性结核组(设为B组)和健康对照组(设为C组)。分别检测三组血浆INF-γ、IL-2、IL-4、IL-10浓度,并比较两组之间的浓度差异,以及比较A组与B组T-SPOT.TB结果阳性者各孔斑点数大小,均以P0.05为差异有统计学意义。如果某细胞因子或某斑点数在A组与B组之间有显著差异,则通过ROC曲线分析,判断其诊断价值大小,当约登指数最大时,此时该细胞因子浓度或斑点数目为鉴别两者的最佳临界值,并算出其诊断灵敏度,特异度以及阳性似然比、阴性似然比。 结果:根据诊断与入组标准,最终纳入研究对象72例,分别是A组32例,B组(包括陈旧性结核16例,结核潜伏感染者4例)20例,C组20例。血浆INF-γ、IL-2、IL-4、IL-10在A组中浓度分别是115.94±14.01,452.95±209.90,260.70±95.73,152.86±37.11,在B组中浓度分别是89.79±4.25,499.78±197.15,260.46±134.33,86.68±15.71,在C组中浓度分别是90.79±3.88,510.10±103.03,204.98±108.81,64.51±9.66。A组与B组相比,INF-γ及IL-10在两组之间均有显著差异,P0.05;IL-2及IL-4在两组之间均无显著差异,P0.05。B组与C组相比,INF-γ及IL-2在两组之间均无显著差异,P0.05;IL-4及IL-10在两组之间均有显著差异,P0.05。A组与B组T-SPOT.TB结果阳性者A孔、B孔及A+B孔斑点数中位数分别是,23与19,74.5与25,115.5与49,A孔及A+B孔斑点数之和在两组之间均无显著差异,P0.05;B孔斑点数在两组之间有显著差异,P0.05。在A组与B组之间,通过对两组B孔斑点数、血浆INF-γ及IL-10浓度做ROC曲线分析,得出AUC分别是0.69,0.95,0.98,以B孔斑点数74.5个,INF-γ浓度94.38pg/ml,IL-10浓度109.82pg/m1分别为临界值,鉴别活动性结核与非活动性结核灵敏度、特异度、阳性似然比、阴性似然比分别是:50.0%,93.8%,93.8%;89.5%,85.0%,90.0%;4.76,6.25,9.38;0.56,0.07,0.07。 结论:1.Th1型/Th2型细胞因子的动态失衡在结核发生发展中起重要作用,可能当Th2型细胞因子占主导地位时促进了结核的发生发展。 2.T-SPOT.TB联合血浆INF-γ、IL-10浓度检测可对结核作出精确诊断,有较高的诊断价值。疑诊结核感染患者可先行T-SPOT.TB检测,当结果阳性时,再测定血浆INF-γ或IL-10的浓度,有助于区分活动性结核与非活动性结核,其中IL-10的阳性似然比更高,更有助于活动性结核病的诊断。 3.活动性结核患者与非活动性结核患者,当T-SPOT.TB结果阳性时,仅B孔斑点数在两者之间有显著差异,但尚不足以凭借B孔斑点数较好区分活动性结核与非活动性结核。图12幅,表3个,参考文献46篇。
[Abstract]:Objective : To evaluate the value of T - SPOT . TB combined with plasma cytokines INF - 纬 and IL - 10 in the differential diagnosis of active tuberculosis and non - active tuberculosis and the changes of Th1 / Th2 cytokines in tuberculosis .
Methods : Seventy - five patients with tuberculosis infection , 75 patients with tuberculosis infection , 75 patients with active tuberculosis ( Group A ) , non - active tuberculosis group ( group B ) and healthy control group ( group C ) were prospectively enrolled .
Results : In group A , the concentrations of INF - 纬 , IL - 2 , IL - 4 , IL - 10 in group A were 89.79 卤 14.01 , 452.95 卤 209.90 , 268.70 卤 95.73 , 152.86 卤 37.11 respectively . The concentrations of INF - 纬 , IL - 2 , IL - 4 and IL - 10 in group A were 89.79 卤 4.25 , 499.78 卤 103.03 , 202.46 卤 103.73 , 86.68 卤 15.71 , respectively , and the concentrations of INF - 纬 and IL - 10 in group B were significantly different than those in group B , P < 0.05 ;
There was no significant difference between the two groups of IL - 2 and IL - 4 , but there was no significant difference between the two groups ( P0.05 ) .
There was a significant difference between the two groups of IL - 4 and IL - 10 . The median number of spots in group A , B and A + B in group A and group B were 23 and 19 , 74 . 5 and 25 , 115 . 5 and 49 respectively , and there was no significant difference between the two groups , P 0 . 05 ;
In group A and group B , the number of B - hole spots , plasma INF - 纬 and IL - 10 concentration were analyzed by ROC curve . The results showed that the AUC were 0.69 , 0.95 and 0.98 respectively , and the sensitivity , specificity , positive likelihood ratio and negative likelihood ratio of active tuberculosis and non - active tuberculosis were 50.0 % , 93.8 % and 93.8 % respectively .
89.5 % , 85.0 % , 90.0 % ;
4.76 , 6.25 , 9.38 ;
0.56 , 0.07 , 0.07 .
Conclusion : 1 . The dynamic imbalance of Th1 / Th2 cytokines plays an important role in the development of tuberculosis , which may promote the development of tuberculosis when Th2 cytokines predominate .
2 . T - SPOT . TB combined with plasma INF - 纬 and IL - 10 concentrations can be used for accurate diagnosis of tuberculosis . It has high diagnostic value . When the results are positive , the concentration of INF - 纬 or IL - 10 can be measured , which helps to distinguish active tuberculosis and non - active tuberculosis . The positive likelihood ratio of IL - 10 is higher , which is helpful for the diagnosis of active tuberculosis .
3 . When T - SPOT . TB results were positive in patients with active tuberculosis , only the number of B - hole spots was significantly different between them , but it was not enough to distinguish active tuberculosis from non - active tuberculosis with B - hole spots . Fig . 12 , Table 3 , Reference 46 .
【学位授予单位】:中南大学
【学位级别】:硕士
【学位授予年份】:2013
【分类号】:R52
【参考文献】
相关期刊论文 前10条
1 张贤兰;吕江青;林兆原;谭耀驹;方琼;谭守勇;刘建雄;;肺结核患者CD4~+T淋巴细胞凋亡及相关细胞因子水平变化[J];广东医学;2008年10期
2 唐神结;结核病免疫研究进展[J];国外医学(内科学分册);2002年09期
3 李志惠;杨永辉;张红漫;田艳茹;刘相;张广宇;;肺结核患者体内细胞因子水平的动态变化与耐药关系的研究[J];河北医药;2008年03期
4 王文虎;龚作炯;;结核性腹膜炎的诊断现状和进展[J];长江大学学报(自科版)医学卷;2007年02期
5 苏俊华;朱莉莉;陈建华;保凌;赵勤;梁桂亮;杨慧仙;施巧霞;段志妹;;T淋巴细胞斑点试验在结核病诊断中的应用[J];中国感染与化疗杂志;2010年04期
6 彭超;王洪海;;结核分枝杆菌潜伏感染诊断方法的新进展[J];生物技术通讯;2010年01期
7 陈卫中,倪宗瓒,潘晓平,刘元元,夏彦;用ROC曲线确定最佳临界点和可疑值范围[J];现代预防医学;2005年07期
8 杨颖乔;彭圣威;;肺结核患者细胞因子水平测定的临床研究[J];咸宁学院学报(医学版);2009年03期
9 沈云飞;殷凯生;王新宁;;肺结核与肺癌患者血IL-12、IFN-γ和IL-4的联合检测及意义[J];江苏医药;2006年12期
10 刘剑君;幺鸿雁;;我国结核病的流行现状和防治对策[J];预防医学论坛;2006年05期
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