T-SPOT-TB法检测脑脊液单个核细胞对早期结核性脑膜炎诊断价值的研究

发布时间：2018-05-17 13:05

本文选题：结核性脑膜炎 + 脑脊液　；参考：《宁夏医科大学》2013年硕士论文

【摘要】：结核性脑膜炎是严重危害人类健康的中枢神经系统感染性疾病，传统的脑脊液分析和放射学检查方法敏感性和特异性较低，延误治疗时机，因此临床急需敏感性更高的快速检测方法用于结核性脑膜炎的早期诊断。本实验采用T细胞酶联免疫斑点试验（ELISPOT）分别检测结核性脑膜炎患者外周血和脑脊液单个核细胞，，并探讨此方法对早期结核性脑膜炎的诊断意义。目的本文采用T细胞酶联免疫斑点试验（ELISPOT）检测结核性脑膜炎患者外周血和脑脊液单个核细胞，比较两种检查方法诊断结核性脑膜炎的敏感性和特异性，为结核性脑膜炎的早期诊断提供有效检查方法。方法分别收集结核性脑膜炎（30例）和非结核性脑膜炎（30例）患者外周血和脑脊液，分离提取单个核细胞，经冻存和复苏后以结核杆菌感染T细胞斑点试验（T-SPOT-TB）检测外周血和脑脊液中γ干扰素分泌的T细胞，分别计算其诊断结核性脑膜炎的灵敏度和特异度。结果脑脊液T-SPOT-TB试验：结核性脑膜炎组阳性检出率为93.33%（28/30），非结核性脑膜炎组为3.33%（1/30）；检测灵敏度93.33%、特异度96.67%，假阳性率3.33%、假阴性率6.67%，阳性似然比28.33、阴性似然比0.07。外周血T-SPOT-TB试验：结核性脑膜炎组阳性检出率为76.67%（23/30），非结核性脑膜炎组为13.33（4/30）；检测灵敏度76.67%、特异度86.67%，假阳性率13.33%、假阴性率23.33%，阳性似然比5.79、阴性似然比0.15。外周血ELISPOT试验阳性检出率与脑脊液阳性检出率比较，差异无统计学意义（Fisher确切概率法：P=0.254），但两种方法的灵敏度和特异度有明显差异。结论外周血和脑脊液单个核细胞ELISPOT试验均可作为当前诊断结核性脑膜炎的有效的诊断方法，而脑脊液单个核细胞ELISPOT试验比外周血单个核细胞ELISPOT试验检测灵敏度和特异度更高。
[Abstract]:Tuberculous meningitis is an infectious disease of the central nervous system that seriously endangers human health. The traditional methods of cerebrospinal fluid analysis and radiologic examination are less sensitive and specific, and delay the treatment. Therefore, a more sensitive and rapid detection method is urgently needed for the early diagnosis of tuberculous meningitis. In this study, the peripheral blood mononuclear cells (PBMC) and cerebrospinal fluid (CSF) mononuclear cells in patients with tuberculous meningitis were detected by T-cell enzyme-linked immunoblot assay (ELISPOT), and the diagnostic significance of this method for early tuberculous meningitis was discussed. Purpose The peripheral blood mononuclear cells (PBMC) and cerebrospinal fluid (CSF) mononuclear cells (CSF) in patients with tuberculous meningitis were detected by T-cell enzyme-linked immunoblot assay (ELISPOT). The sensitivity and specificity of the two methods in the diagnosis of tuberculous meningitis were compared. To provide an effective method for early diagnosis of tuberculous meningitis. Method Peripheral blood and cerebrospinal fluid were collected from 30 cases of tuberculous meningitis and 30 cases of non-tuberculous meningitis, and mononuclear cells were isolated and extracted. After cryopreservation and resuscitation, T-SPOT-TB was used to detect the T cells secreted by interferon 纬 in peripheral blood and cerebrospinal fluid, and their sensitivity and specificity in diagnosis of tuberculous meningitis were calculated. Result T-SPOT-TB test of cerebrospinal fluid showed that the positive rate of tuberculous meningitis was 93.33 / 28 / 30 and that of non-tuberculous meningitis was 3.33 / 30, the sensitivity was 93.33 and the specificity was 96.677.The false positive rate was 3.333.33, the false negative rate was 6.67 and the positive likelihood ratio was 28.33 and the negative likelihood ratio was 0.07. In peripheral blood T-SPOT-TB test, the positive rate of tuberculous meningitis was 76.677 / 23 / 30 and that of non-tuberculous meningitis was 13.33 / 4 / 30.The sensitivity was 76.677.The specificity was 86.67g, the false positive rate was 13.3333 and the false negative rate was 23.333.The positive likelihood ratio was 5.79 and the negative likelihood ratio was 0.15. The positive rate of ELISPOT test in peripheral blood was not significantly different from that in cerebrospinal fluid (CSF), but the sensitivity and specificity of the two methods were significantly different. Conclusion The ELISPOT test of mononuclear cells in peripheral blood and cerebrospinal fluid can be used as an effective diagnostic method in diagnosis of tuberculous meningitis. The sensitivity and specificity of mononuclear cell ELISPOT test in cerebrospinal fluid is higher than that in peripheral blood mononuclear cell ELISPOT test.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.3

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