T-SPOT.TB试验在结核性胸腔积液诊断中的应用价值

  本文关键词：T-SPOT.TB试验在结核性胸腔积液诊断中的应用价值，由笔耕文化传播整理发布。

        目的探讨T-SPOT.TB试验在结核性胸腔积液诊断中的应用价值方法分离69例胸腔积液患者的外周血单个核细胞(PBMCs)和胸腔积液单个核细胞(PEMCs)，经早期分泌抗原靶6kD(ESAT-6)和培养滤液蛋白10kD(CFP-10)抗原共同孵育,进行酶联免疫斑点试验（ELISPOT试验）,检测经抗原刺激后分泌γ干扰素的效应T淋巴细胞,即斑点形成细胞(SFCs)的数量，以中位数、四分位间距表示，根据使用说明评价其敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比，并根据受试者工作特征曲线(ROC曲线)建立合理的临床判断临界值及其检测的敏感性和特异性。结果69例病人中5例获得不确定结果，64例获得有效结果，最终34例诊断为结核性胸腔积液，30例诊断为非结核性胸腔积液。结核性胸腔积液组中，sESAT-6、pESAT-6、sCFP-10和pCFP-10抗原(s表示外周血，p表示胸水)形成的斑点形成细胞(SFCs)中位数和四分位数间距分别为22、15-27.5，94、48.75-231，20、14.25-26.25，114、47.25-245.5。30例非结核性胸腔积液组中，sESAT-6、pESAT-6、sCFP-10和pCFP-10抗原形成的斑点形成细胞(SFCs)中位数和四分位数间距分别为3、2-5，2、1-3，3、2-4和3、1.75-4。结核组2种抗原在外周血及胸水中的SFCs均高于非结核组（p＜0.05）。结核组2种抗原在胸水中的SFCs高于外周血的SFC（sp＜0.05）。非结核组胸水和外周血中2种抗原的SFCs无统计学差异（p＞0.05）。sESAT-6、sCFP-10、pESAT-6、pCFP-10、sT-SPOT.TB和pT-SPOT.TB诊断结核的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为：85.29%、90%、90.63%、84.38%、8.53、0.16；79.41%、93.33%、93.10%、80%、11.91、0.22；91.18%、83.33%、86.11%、89.29%、5.47、0.11；91.18%、83.33%、86.11%、89.29%、5.47、0.11；88.24%、86.67%、88.24%、86.7%、6.62、0.14；91.18%、83.33%、86.11%、89.29%、5.47、0.11。sESAT-6、sCFP-10、pESAT-6和pCFP-10抗原诊断结核性胸腔积液的ROC曲线下面积（AUC）、临界值(cut-off point)、敏感性、特异性分别为：0.877、11、85.3%、90%，0.903、11、79.4%、93.3%，0.929、14.5、91.2%、83.3%和0.937、30、88.2%、90%。结论T-SPOT.TB能够辅助诊断结核性胸腔积液，具有较高的敏感性和特异性。

    Objective To investigate the diagnostic value of T-SPOT.TB assay for tuberculosispleural effusion.Methods The peripheral blood mononuclear cells（PBMCs） and pleural effusionmononuclear cells (PEMCs) were separated from69patients. Then the early secretoryantigenic target6(ESAT-6) and culture filtered protein10were co-cultured.Then Tlymphocytes releasing interferon-γ were detected which record as spot formingcells(SFCs) with a median and interquartile range by ELISPOT assay. Sensitivity,specificity, positive predictive value, negative predictive value, positive likelihood ratio,negative likelihood ratio were also detected. The optimum cut-off points resultingfrom the best sensitivity-specificity balance in the ROC curves were constructed.Results Five of the69patients gave indeterminate ELISPOT assay results.34patientswere dignosised with tuberculosis pleural effusion, and30patients were dignosisedwith no-tuberculosis pleural effusion. The median and interquartile range of SFCs fromsESAT-6、pESAT-6、sCFP-10and pCFP-10（s represent blood，p represent plural）were22、15-27.5，94、48.75-231，20、14.25-26.25and114、47.25-245.5respectivelywith tuberculosis pleural effusion.The median and interquartile range of SFC fromsESAT-6、pESAT-6、sCFP-10and pCFP-10were3、2-5，，2、1-3，3、2-4，3and1.75-4respectively with no-tuberculosis pleural effusion. The number of ESAT-6and CFP-10specific cells in the pleural fluid or peripheral blood in TB group are both higher than the number in NTB group（p＜0.05）.The number of ESAT-6and CFP-10specific cellsin the pleural fluid are higher than the number in peripheral blood in TB group（p＜0.05）,which can not be found in NTB group（p＞0.05）.The sensitivity, specificity,positive predietive value,Negative predictive value,positive likelihood ratioand negative likelihood ratio of sESAT-6，pESAT-6，sCFP-10,pCFP-10,sT-SPOT andpT-SPOT to diagnosis tuberculosis pleural effusion were85.29%、90%、90.63%、84.38%、8.53、0.16；79.41%、93.33%、93.10%、80%、11.91、0.22；91.18%、83.33%、86.11%、89.29%、5.47、0.11；91.18%、83.33%、86.11%、89.29%、5.47、0.11；88.24%、86.67%、88.24%、86.7%、6.62、0.14；91.18%、83.33%、86.11%、89.29%、5.47、0.11respectively.The ROC area,cut-off value, sensitivity and specificity were0.877、11、85.3%、90%，0.903、11、79.4%、93.3%，0.929、14.5、91.2%、83.3%and0.937、30、88.2%、90%.Conclusion The T-SPOT.TB assay could be used to detect TB infection and to assistthe diagnosis for tuberculosis pleural effusion,because of its high sensitivity andspecificity.

        T-SPOT.TB试验在结核性胸腔积液诊断中的应用价值

英文缩略词表5-6中文摘要6-8Abstract8-9引言10-12材料和方法12-16结果16-21讨论21-27结论27-28参考文献28-33附录33-34致谢34-35综述35-48    参考文献43-48

  本文关键词：T-SPOT.TB试验在结核性胸腔积液诊断中的应用价值，由笔耕文化传播整理发布。