T-SPOT.TB在结核性心包炎中的诊断价值
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摘要
目的:研究结核感染T细胞斑点实验(T-SPOT.TB)在结核性心包炎中的诊断价值。方法:选取2012年5月至2016年7月江西省胸科医院收治的心包炎患者60例,分为结核性和非结核性心包炎两组,常规行外周血T-SPOT.TB检测,中量积液以上患者行心包积液T-SPOT.TB检测,对比两组患者T-SPOT.TB检测的差异。结果:在结核性心包炎组,心包积液的T-SPOT.TB特异及灵敏度分别达到了93.1%及90.3%,阳性和阴性预测值分别为93.3%和90%,较外周血有更好的诊断价值;抗原表达方面,结核性心包炎组ESAT-6及CFP-10较非结核性心包炎组有更高的表达值;在结核性心包炎组,合并活动性肺结核较未合并活动性肺结核患者T-SPOT.TB双抗原有更高的表达值,其中ESAT-6抗原表达强于CFP-10。结论:T-SPOT.TB对结核性心包炎有比较好的特异度和灵敏度,是一种有效的辅助诊断工具。
Objective To investigate the diagnostic value of T lymphocytes spot test of tuberculosis(TSPOT.TB) in tuberculous pericarditis. Methods Sixty patients with pericarditis in Jiangxi Chest Hospital from May 2012 to July 2016 were enrolled in this study. The patients were divided into two groups : the tuberculous pericarditis group and the nontuberculous pericarditis group. The peripheral blood of each patient was used for detection of T-SPOT.TB. The pericardial effusion was also used for detection of T-SPOT.TB in patients with over medium pericardial effusion. Results In the tuberculous pericarditis group, the specificity and sensitivity of TSPOT.TB peripheral blood were 93.1% and 90.3%, respectively; and the positive predictive value and negative predictive value were 93.3% and 90%, respectively. The diagnostic value of pericardial effusion was better than peripheral blood. In terms of antigen expression, ESAT-6 and CFP-10 in the tuberculous pericarditis group were higher than those in the nontuberculous pericarditis group. In the tuberculous pericarditis group, the two antigen expression were higher in patients combined with active tuberculosis compared with patients not combined with active tuberculosis, and the expression of ESAT-6 was higher than CFP-10. Conclusions The T-SPOT.TB test has higher specificity and sensitivity and it can be used as an auxiliary diagnostic method for tuberculous pericarditis.
Objective To investigate the diagnostic value of T lymphocytes spot test of tuberculosis(TSPOT.TB) in tuberculous pericarditis. Methods Sixty patients with pericarditis in Jiangxi Chest Hospital from May 2012 to July 2016 were enrolled in this study. The patients were divided into two groups : the tuberculous pericarditis group and the nontuberculous pericarditis group. The peripheral blood of each patient was used for detection of T-SPOT.TB. The pericardial effusion was also used for detection of T-SPOT.TB in patients with over medium pericardial effusion. Results In the tuberculous pericarditis group, the specificity and sensitivity of TSPOT.TB peripheral blood were 93.1% and 90.3%, respectively; and the positive predictive value and negative predictive value were 93.3% and 90%, respectively. The diagnostic value of pericardial effusion was better than peripheral blood. In terms of antigen expression, ESAT-6 and CFP-10 in the tuberculous pericarditis group were higher than those in the nontuberculous pericarditis group. In the tuberculous pericarditis group, the two antigen expression were higher in patients combined with active tuberculosis compared with patients not combined with active tuberculosis, and the expression of ESAT-6 was higher than CFP-10. Conclusions The T-SPOT.TB test has higher specificity and sensitivity and it can be used as an auxiliary diagnostic method for tuberculous pericarditis.
引文
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[10]石慧,崔丽英.结核感染T细胞斑点试验诊断结核性胸膜炎的应用价值[J].中华肺部疾病杂志(电子版),2015,8(2):51-54.
[11]王立红,付秀华,张桂芝,等.结核感染T细胞斑点试验在结核病诊断中的应用价值[J].中国防痨杂志,2013,35(12):992-996.
[12]JAFARI C,ERNST M,KALSDORF B,et al.Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot[J].Am J Respir Crit Care Med,2006,174(9):1048-1054.
[13]LOSI M,BOSSINK A,CODECASA L,et al.Use of a T-cell interferon-gamma release assay for the diagnosis of tuberculous pleurisy[J].Eur Respir J,2007,30(6):1173-1179.
[14]LEE JY,CHOI HJ,PARK IN,et al.Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection[J].Eur Respir J,2006,28(1):24-30.
[15]杨昌恒,廖江荣,徐巧伶.T-spo T在结核性胸膜炎的临床诊断价值[J].实用医学杂志,2015,31(19):3279-3280.
[2]IWAGAITSU S,NANIWA T,MAEDA S,et al.A comparative analysis of two interferon-gamma releasing assays to detect past tuberculosis infections in Japanese rheumatoid arthritis patients[J].Mod Rheumatol,2016,26(5):690-695.
[3]SHI XC,ZHANG LF,ZHANG YQ,et al.Clinical and laboratory diagnosis of intestinal tuberculosis[J].Chin Med J(Engl),2016,129(11):1330-1333.
[4]MAYOSI BM,BURGESS LJ,Doubell AF.Tuberculous pericarditis[J].Circulation,2005,112(23):3608-3616.
[5]KIM SH,SONG KH,CHOI SJ,et al.Diagnostic usefulness of a T-cell-based assay for extrapulmonary tuberculosis in immunocompromised patients[J].Am J Med,2009,122(2):189-195.
[6]JIA H,PAN L,DU B,et al.Diagnostic performance of interferon-gamma release assay for lymph node tuberculosis[J].Diagn Microbiol Infect Dis,2016,85(1):56-60.
[7]HAN J,ZENG F,ZHOU Y.The Value of T-SPOT.TB in early diagnosis of tracheobronchial tuberculosis[J].Sarcoidosis Vasc Diffuse Lung Dis,2015,32(4):336-341.
[8]ADILISTYA T,ASTRAWINATA DA,NASIR UZ.Use of pleural fluid interferon-gamma enzyme-linked immunospot assay in the diagnosis of pleural tuberculosis[J].Acta Med Indones,2016,48(1):41-47.
[9]高亮,郑建,欧勤芳,等.结核感染T细胞斑点试验对结核性胸膜炎的诊断价值分析[J].实用医学杂志,2015,31(17):2833-2835.
[10]石慧,崔丽英.结核感染T细胞斑点试验诊断结核性胸膜炎的应用价值[J].中华肺部疾病杂志(电子版),2015,8(2):51-54.
[11]王立红,付秀华,张桂芝,等.结核感染T细胞斑点试验在结核病诊断中的应用价值[J].中国防痨杂志,2013,35(12):992-996.
[12]JAFARI C,ERNST M,KALSDORF B,et al.Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot[J].Am J Respir Crit Care Med,2006,174(9):1048-1054.
[13]LOSI M,BOSSINK A,CODECASA L,et al.Use of a T-cell interferon-gamma release assay for the diagnosis of tuberculous pleurisy[J].Eur Respir J,2007,30(6):1173-1179.
[14]LEE JY,CHOI HJ,PARK IN,et al.Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection[J].Eur Respir J,2006,28(1):24-30.
[15]杨昌恒,廖江荣,徐巧伶.T-spo T在结核性胸膜炎的临床诊断价值[J].实用医学杂志,2015,31(19):3279-3280.