CFP-10和ESAT-6检测对结核性脑、胸膜炎早期诊断意义的研究

发布时间：2018-04-25 05:27

本文选题：CFP-10 + ESAT-6　；参考：《宁波大学》2013年硕士论文

【摘要】：结核病一直以来严重危害着人们的健康，全世界大约有30%的人口感染了结核，其中发展中国家更甚。在肺外结核中，结核性脑膜炎(Tubercular meningitis,TBM)最为致命，结核性胸膜炎（Tuberculous pleurisy,TBP)则较为常见。TBM的高死亡率导致患者痊愈后往往留下严重的神经系统功能缺损。由于细菌培养较为困难及费时、现在仍然依据临床症状，胸部影像学表现，实验室检查等综合表现来进行综合诊断。结核杆菌特异性分泌蛋白早期分泌靶6000蛋白（ESAT-6）和培养滤液蛋白10（CFP-10）的出现给诊断结核带来新的契机，通过应用酶联免疫吸附法（enzymelinked immunosorbent assay，ELISA）方法来检测特定部位的特异性蛋白的含量能够提高对结核的诊断率。目的：应用ELISA法检测脑脊液及胸水中ESAT-6和CFP-10的含量，以早期辅助诊断结核性脑、胸膜炎。方法：将收集的29例阳性病例（结核性脑膜炎及胸膜炎的病人）和30例对照病例应用ELISA检测其脑脊液或胸水ESAT-6和CFP-10蛋白，并与用聚丙烯酰胺凝胶块浓缩脑脊液或胸水后检测ESAT-6和CFP-10蛋白浓度,再与未浓缩前的结果进行比较。结果：浓缩前后病例组与对照组的CFP-10和ESAT-6蛋白的阳性率有显著差异，P0.01，浓缩前的标本：CFP-10的灵敏度为62.1%(95%置信区间[CI],39-76)，特异度为86.7%(95%CI,69-96)。ESAT-6的灵敏度为68.9%(95%CI,49-85)，特异度为90%(95%CI,73-98)。两蛋白联合诊断的灵敏度为79.3%(95%CI,60-92)，特异度为96.7%（95%CI,83-100)。浓缩后的标本： CFP-10的灵敏度为68.9%(95%CI,49-85)，特异度为86.7%(95%CI,69-96)。 ESAT-6的灵敏度为72.4%(95%CI,53-87)，特异度为90%(95%CI,73-98)，两蛋白联合诊断的灵敏度为89.6%(95%CI,63-98)，特异度为96.7%（95%CI,83-100)。病例组CFP-10和ESAT-6蛋白之间的灵敏度及特异度比较无显著差异，P0.05。浓缩前两蛋白联合诊断的灵敏度较单个蛋白CFP-10之间有差异，P0.05,较ESAT-6蛋白无差异，，P0.05。浓缩后两蛋白联合诊断的灵敏度较单个蛋白无显著差异,浓缩前后两蛋白联合诊断的特异度较ESAT-6和CFP-10蛋白均无差异，P0.05。结论: ESAT-6和CFP-10ELISA检测结核具有较高的灵敏度和特异度，且两个蛋白联合诊断的灵敏度较单个蛋白(CFP-10)的高，另此法较为简便和廉价，适合用于结核性脑膜炎和胸膜炎的早期辅助诊断。
[Abstract]:Tuberculosis has been a serious threat to people's health. About 30 percent of the world's population is infected with tuberculosis, especially in developing countries. In extrapulmonary tuberculosis, tuberculous meningitis TBMis is the most fatal, and tuberculous pleurisy TBPPs are more common. The high mortality rate of. TBM often leads to severe neurological impairment after recovery. Because bacteria culture is difficult and time-consuming, comprehensive diagnosis is still based on clinical symptoms, chest imaging findings, laboratory examination and so on. The emergence of mycobacterium tuberculosis specific secretory protein ESAT-6 and culture filtrate protein 10CFP-10 brings a new opportunity for the diagnosis of tuberculosis. Enzyme linked immunosorbent assay (Elisa) was used to detect the specific protein content in specific parts of tuberculosis by enzyme linked immunosorbent assaysa (Elisa) method, which could improve the diagnosis rate of tuberculosis. Objective: to detect the contents of ESAT-6 and CFP-10 in cerebrospinal fluid and pleural effusion by ELISA method in order to diagnose tuberculous meningitis and pleurisy in early stage. Methods: ELISA was used to detect ESAT-6 and CFP-10 protein in cerebrospinal fluid or pleurisy of 29 positive cases (tuberculous meningitis and pleurisy) and 30 control cases. The results were compared with those before concentration of ESAT-6 and CFP-10 protein in CSF or pleural effusion. Results: the positive rates of CFP-10 and ESAT-6 protein were significantly different between the two groups before and after concentration. The sensitivity of the sample before and after concentration was 62.1% 95% confidence interval [CI] 39-76, the specificity was 86.7% 95CIN 69-960.The sensitivity of ESAT-6 was 68.9% 95CII 49-85, and the specificity was 90,95CI73-980.Results: the positive rate of CFP-10 and ESAT-6 protein was significantly higher than that of control group before and after concentration. The sensitivity of the sample before and after concentration was 62.1% and 95% confidence interval [CI], and the specificity was 68.9% and 73-98%, respectively. The sensitivity of the combined diagnosis of the two proteins is 79.3% and the specificity is 96.795 / 95 CI83-100. The sensitivity of CFP-10 was 68.9% and the specificity was 86.7%. The sensitivity of ESAT-6 is 72. 4% and 95%. The specificity is 90. 95%. The sensitivity of the combined diagnosis of the two proteins is 89. 6 and 95. The sensitivity of the two proteins is 89. 6 and 95. The specificity is 96. 795. The specificity is 83-100. There was no significant difference in sensitivity and specificity between CFP-10 and ESAT-6 protein. The sensitivity of the two proteins in the combined diagnosis was higher than that in the single protein CFP-10 (P 0.05), but no difference was found between the two proteins (P 0.05) than that of the ESAT-6 protein (P 0.05). There was no significant difference in the sensitivity of the combined diagnosis of the two proteins compared with that of the single protein, and the specificity of the combined diagnosis of the two proteins before and after concentration was not different from that of the ESAT-6 and CFP-10 proteins (P 0.05). Conclusion: ESAT-6 and CFP-10ELISA have high sensitivity and specificity in the detection of tuberculosis, and the sensitivity of the combined diagnosis of the two proteins is higher than that of single protein CFP-10. It is suitable for early diagnosis of tuberculous meningitis and pleurisy.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521.7;R529.3

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