T-SPOT TB在结核性胸膜炎诊断中应用价值的研究

发布时间：2018-07-11 21:18

  本文选题：结核性胸膜炎诊断 + T-SPOT　； 参考：《吉林大学》2013年硕士论文

【摘要】：结核性胸膜炎是最常见的肺外结核病，也是胸腔积液最常见的原因。由于该病在临床上缺乏特异性表现，用胸液细菌学方法检测阳性率低，胸膜活检的创伤性限制了其在临床的推广应用，分子生物学虽然提供了快速诊断技术，但是仍然存在假阳性及技术等方面的问题，给结核性胸膜炎的早期诊断带来一定难度，T-SPOT TB是近年来兴起的检测细胞免疫功能的一种方法，此方法灵敏度高，特异性好，逐渐成为结核诊断研究的热点。本研究通过对93例住院的胸腔积液患者进行外周血T-SPOT TB检测，探讨T-SPOT TB在结核性胸膜炎中的临床应用价值。 目的：通过对胸腔积液患者外周血进行T-SPOT TB检测，并与胸腔积液中腺苷脱氨酶(ADA)检测、血清结核抗体检测、胸水结核菌培养比较，探讨T-SPOT TB（结核感染T细胞斑点试验）在结核性胸膜炎诊断及鉴别诊断中的临床应用价值。 方法：受试者共93例，结核性胸膜炎患者48例，恶性胸腔积液45例。用T-SPOT TB检测上述受试者的外周血单个核细胞（PBMC）中对结核分枝杆菌早期分泌靶向抗原6（Early secretory antigen target-6,ESAT-6）和/或培养滤液蛋白10（Culture filtrate protein-10,CFP-10）致敏的T淋巴细胞即斑点形成细胞（Spot forming cell，SFC）的数量，并与其他相关指标：胸腔积液中腺苷脱氨酶(ADA)、血清结核抗体检测、胸水结核菌培养进行比较。 结果： 1、T-SPOT TB检测在结核性胸膜炎组阳性率为91.67%，显著高于恶性胸腔积液的阳性率：8.89%，差异具有统计学意义（P0.05） 2、联合应用早期分泌靶向抗原6（ESAT-6）和培养滤液蛋白10（CFP-10）的敏感性（91.67%）高于单用ESAT-6的敏感性（85.42%）或单用CFP-10的敏感性（75.00%），但联用与单用任一抗原的敏感性差别无统计学意义。 3、T-SPOT TB、胸腔积液中腺苷脱氨酶(ADA)检测、血清结核抗体检测、胸水结核菌培养的敏感性分别为91.67%、70.83%、62.50%、14.58%，特异性分别为91.11%、55.56%、62.50%、100%，诊断准确率分别为94.24%、63.44%、62.37%、55.91%，T-SPOT TB检测的敏感性高于其他检验方法，，其差异具有统计学意义（P0.05）。 结论：T-SPOT TB可用于结核性胸膜炎的诊断和鉴别诊断。在诊断结核性胸膜炎时T-SPOT TB拥有较高的敏感性、特异性、和诊断准确率，T-SPOT TB对结核性胸膜炎的早期诊断具有较高的应用价值，值得在临床广泛推广和应用。
[Abstract]:Tuberculous pleurisy is the most common extrapulmonary tuberculosis and the most common cause of pleural effusion. Due to the lack of specific clinical manifestations, the positive rate of pleural fluid bacteriology is low, and the traumatic pleural biopsy limits its clinical application. Molecular biology provides a rapid diagnostic technique. However, there are still some problems in false positives and techniques, which make it difficult for the early diagnosis of tuberculous pleurisy. T-spot TB is a new method to detect cellular immune function in recent years. This method has high sensitivity and good specificity. It has gradually become a hot spot in tuberculosis diagnosis. In this study, the clinical value of T-spot TB in tuberculous pleurisy was studied by detecting T-spot TB in 93 patients with pleural effusion. Objective: to detect T-spot TB in peripheral blood of patients with pleural effusion and compare it with adenosine deaminase (ADA) in pleural effusion, serum tuberculosis antibody and culture of tuberculous bacteria in pleural effusion. To evaluate the clinical value of T-spot TB (T-spot TB) in the diagnosis and differential diagnosis of tuberculous pleurisy. Methods: there were 93 cases of tuberculous pleurisy, 48 cases of tuberculous pleurisy and 45 cases of malignant pleural effusion. T-spot TB was used to detect the number of T lymphocytes sensitized with early secretory antigen target-6 ESAT-6 and / or culture filtrate protein-10 CFP-10 in peripheral blood mononuclear cells (PBMCs) of these subjects. And compared with other related indexes: adenosine deaminase (ADA) in pleural effusion, detection of serum tuberculosis antibody and culture of tuberculous bacteria in pleural effusion. Results: 1 the positive rate of T-spot TB in tuberculous pleurisy was 91.67, which was significantly higher than that in malignant pleural effusion (P 0.05). The sensitivity of culture filtrate protein 10 (CFP-10) (91.67%) was higher than that of ESAT-6 alone (85.42%) or CFP-10 alone (75.00%). The sensitivity of tuberculous bacillus culture in serum was 91.67 and 70.83 and the sensitivity was 62.50 and 14.58, and the specificity was 91.115.56 and 62.500.100, respectively. The diagnostic accuracy was 94.240.63.440.62.37 and the sensitivity of T-SPOT TB was higher than that of other test methods, and the difference was statistically significant (P0.05). Conclusion: t-spot TB can be used in the diagnosis and differential diagnosis of tuberculous pleurisy. T-spot TB has high sensitivity, specificity and diagnostic accuracy in the diagnosis of tuberculous pleurisy. T-spot TB has a high value in early diagnosis of tuberculous pleurisy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521.7

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3 马s

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