PPD试验、结明三项联合ESAT-6检测在菌阴肺结核诊断中的价值

发布时间：2018-04-30 19:06

本文选题：PPD试验 + 结明三项　；参考：《郑州大学》2012年硕士论文

【摘要】：目的探讨结核菌素纯蛋白衍生物皮肤试验(PPD试验)、结明三项(TB-CHECK试验、TB-DOT试验、TB-Ab试验)联合6kD早期分泌抗原诱导的γ干扰素释放反应(ESAT-6检测)在菌阴肺结核诊断中的价值。对象与方法搜集河南省胸科医院呼吸内科和结核科在2011年1月至2012年2月期间收治的资料比较完整的病例328例,其中初治菌阴肺结核106例,初治菌阳肺结核89例,肺部其他疾病133例。初治菌阴肺结核组：共106例,其中男65例,女41例,年龄4-79岁,平均年龄为34.07-17.69岁,患者有典型的临床表现及胸部X线(或胸部CT)存在活动性肺结核征象,已排除其他非结核性的肺部疾病,均符合中华医学会结核病学分会于2001年制定的《肺结核诊断与治疗指南》中活动性菌阴肺结核的相关诊断标准。此组没有应用抗结核药物治疗或者治疗时间不超过一个月,以减少抗结核治疗对检查结果的影响。此组主要用来评估各项指标联合检测的诊断价值。初治菌阳肺结核组：共89例,其中男51例,女38例,年龄14-88岁,平均年龄为41.13±21.06岁,其诊断均符合国际传染性肺结核诊断标准。此组主要用来评估各项检测指标的敏感性。肺部其他疾病组：共133例,其中男84例,女49例,年龄4-87岁,平均年龄为57.72±18.30岁。其中小细胞肺癌10例,肺腺癌36例,肺鳞癌20例,大细胞肺癌2例,神经鞘瘤1例,慢性阻塞性肺疾20例,肺炎9例,支气管扩张19例,肺脓肿5例,慢性支气管8炎,其他3例。均经相关检查确诊并排除合并有肺结核的存在,此组用于评价各项检测方法的特异性。统计学方法应用SPSS13.0统计软件对数据进行分析,计数资料组间显著性检验比较采用χ2检验,设定标准a=0.05,P0.05认为差异有统计学意义。结果 1.PPD试验、结明三项、ESAT-6检测中的各项指标在菌阴肺结核组的阳性率均高于肺部非结核疾病组,各项检测指标在两组间的比较有统计学意义(P0.05)。 2.PPD试验、结明三项、ESAT-6检测中的各项检测指标中以ESAT-6检测的诊断指数157.22%最高,诊断效能最好。其敏感性及特异性分别为79.78%、77.44%。 3.随着联合指标的增多,菌阴肺结核的阳性检出率逐渐增高。有ESAT-6检测参与的2联、3联的阳性率均高于无ESAT-6检测参与组,其差异有统计学意义(P0.05),而4联的阳性率相近,其差异无统计学意义(P0.05)。 4.在各项指标的联合检测中,以ESAT-6+PPD+TB-Ab的诊断指数152.05%最高,诊断效能最好,其敏感性和特异性分别为93.40%、58.65%。结论多项检测指标联合检测较单项检测可以提高菌阴肺结核诊断的敏感性。ESAT-6+PPD+TB-Ab三项指标联合检测为最佳组合。
[Abstract]:Purpose To investigate the diagnostic value of PPD test and TB-DOT test combined with interferon 纬 release response induced by early secretion antigen of 6kD (PPD test and TB-DOT test combined with ESAT-6 test) in the diagnosis of pulmonary tuberculosis of bacterioculmonary vulva (PPD test) and TB-DOT test (TB-DOT test) combined with interferon 纬 release response induced by early secreting antigen of 6kD. Objects and methods From January 2011 to February 2012, 328 cases with complete data were collected from Department of Respiratory Medicine and Department of Tuberculosis, Henan chest Hospital. Among them, 106 cases were first treated with bacilli negative tuberculosis, 89 cases were initially treated with bacillus positive tuberculosis and 133 cases with other pulmonary diseases. There were 106 cases of pulmonary tuberculosis of bacterial negative, including 65 males and 41 females, aged 4-79 years, with an average age of 34.07-17.69 years. The patients had typical clinical manifestations and active pulmonary tuberculosis signs on chest X-ray (or chest CTS). Other non-tuberculous pulmonary diseases have been excluded, which are in line with the diagnostic criteria of active bacilli negative tuberculosis in the guidelines for the diagnosis and treatment of Pulmonary Tuberculosis, formulated by the Chinese Medical Association Tuberculosis Society in 2001. This group was not treated with antituberculous drugs or for less than a month to reduce the impact of antituberculotic therapy on the results of the examination. This group is mainly used to evaluate the diagnostic value of combined detection of various indicators. A total of 89 cases (51 males and 38 females, aged 14-88 years, with an average age of 41.13 卤21.06 years) were treated with bacillus positive pulmonary tuberculosis. All of them were in accordance with the international diagnostic criteria for infectious pulmonary tuberculosis. This group is mainly used to evaluate the sensitivity of the various indicators. There were 133 patients with other pulmonary diseases, including 84 males and 49 females, aged 4-87 years, with an average age of 57.72 卤18.30 years. There were 10 cases of small cell lung cancer, 36 cases of lung adenocarcinoma, 20 cases of lung squamous cell carcinoma, 2 cases of large cell lung cancer, 1 case of neurilemmoma, 20 cases of chronic obstructive pulmonary disease, 9 cases of pneumonia, 19 cases of bronchiectasis, 5 cases of pulmonary abscess and 8 cases of chronic bronchitis. Other 3 cases. All the patients were diagnosed by correlation examination and the presence of pulmonary tuberculosis was excluded. This group was used to evaluate the specificity of each detection method. Statistical method The statistical software of SPSS13.0 was used to analyze the data. 蠂 2 test was used to compare the significant test among the counting data groups, and the difference was statistically significant in setting the standard a0.05% (P0.05). Result In 1.PPD test, the positive rate of ESAT-6 was significantly higher in pulmonary tuberculosis group than in pulmonary non-tuberculosis group, and there was significant difference between the two groups. In the 2.PPD test, the diagnostic index of ESAT-6 was the highest among the three items of ESAT-6, and the diagnostic efficiency was the best. The sensitivity and specificity were 79.78 and 77.44 respectively. 3. With the increase of combined indexes, the positive detection rate of bacilli-negative pulmonary tuberculosis increased gradually. The positive rate of two and three pairs of ESAT-6 was higher than that of the group without ESAT-6 detection, the difference was statistically significant (P 0.05), but the positive rate of the four groups was similar, the difference was not statistically significant (P 0.05). 4. The diagnostic index of ESAT-6 PPD TB-Ab was 152.05%, and the diagnostic efficiency was the best. The sensitivity and specificity were 93.404.65% and 58.65%, respectively. Conclusion The combined detection of multiple detection indexes can improve the sensitivity of the diagnosis of negative pulmonary tuberculosis. ESAT-6 PPD TB-Ab combined detection is the best combination.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521

【参考文献】