T-SPOT.TB与sPD-L1检测对结核性胸腔积液的诊断价值
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摘要
目的探讨结核感染T细胞斑点试验(T-SPOT.TB)、可溶性程序性死亡配体1(soluble programmed death ligand-1, sPD-L1)单独及联合检测在结核性胸腔积液诊断中的应用价值。方法我院于2016年1月至2018年1月期间收治的140例结核性胸腔积液患者为结核组,选择同时期收治的140例非结核性胸腔积液患者为非结核组,取血进行T-SPOT.TB,取胸腔积液测定sPD-L1水平,分析T-SPOT.TB、sPD-L1单独或联合诊断结核性胸腔积液的诊断效能。结果结核组T-SPOT.TB阳性率为87.1%,非结核组阳性率为9.3%,结核组阳性率显著高于非结核组( 2=169.945,P<0.001);结核组胸腔积液sPD-L1水平显著高于非结核组,差异显著(t=21.345,P<0.001);单独的T-SPOT.TB、sPD-L1诊断结核性胸腔积液,敏感度、特异度差异无统计学意义(P>0.05);平行联合检测的敏感度显著高于系列联合检测(P<0.05),且显著高于各单项检测(P<0.05);系列联合检测的特异度显著高于平行联合检测(P<0.05),且显著高于各单项检测(P<0.05)。结论 T-SPOT.TB、sPD-L1联合检测可提高结核性胸腔积液诊断的灵敏度与特异度,对疾病的早期诊断具有重要价值。
Objective To explore the clinical value of T-SPOT.TB and sPD-L1 in the diagnosis of tuberculous pleural effusion. Methods 140 tuberculous pleural effusion patients admitted from January 2016 to January 2018 were chosen as the TB group and 140 patients with non-tuberculous pleural effusion admitted during the same periods were chosen as the non-HCA group. The results of T-SPOT.TB and sPD-L1 test were measured, and the value of T-SPOT.TB and sPD-L1 in the diagnosis of tuberculous pleural effusion were analyzed. Results The positive rate of T-SPOT.TB in the TB group was 87.1%, and the positive rate in the non-TB group was 9.3%( 2=169.945, P<0.001). The level of sPD-L1 in the TB group was significantly higher than in the non-TB group(t=21.345, P<0.001). There was no statistically significant difference between the two groups in sensitivity and specificity(P>0.05). The sensitivity of parallel combined testing was significantly higher than that of serial combined testing and each single test(P<0.05). The specificity of series combined testing was significantly higher than that of parallel combined testing and each single test(P<0.05). Conclusion T-SPOT.TB and sPD-L1 parallel combined testing can improve the sensitivity of diagnosis of tuberculous pleural effusion, and serial combined testing can improve the specificity, which is of great value for the early diagnosis of tuberculous pleural effusion.
Objective To explore the clinical value of T-SPOT.TB and sPD-L1 in the diagnosis of tuberculous pleural effusion. Methods 140 tuberculous pleural effusion patients admitted from January 2016 to January 2018 were chosen as the TB group and 140 patients with non-tuberculous pleural effusion admitted during the same periods were chosen as the non-HCA group. The results of T-SPOT.TB and sPD-L1 test were measured, and the value of T-SPOT.TB and sPD-L1 in the diagnosis of tuberculous pleural effusion were analyzed. Results The positive rate of T-SPOT.TB in the TB group was 87.1%, and the positive rate in the non-TB group was 9.3%( 2=169.945, P<0.001). The level of sPD-L1 in the TB group was significantly higher than in the non-TB group(t=21.345, P<0.001). There was no statistically significant difference between the two groups in sensitivity and specificity(P>0.05). The sensitivity of parallel combined testing was significantly higher than that of serial combined testing and each single test(P<0.05). The specificity of series combined testing was significantly higher than that of parallel combined testing and each single test(P<0.05). Conclusion T-SPOT.TB and sPD-L1 parallel combined testing can improve the sensitivity of diagnosis of tuberculous pleural effusion, and serial combined testing can improve the specificity, which is of great value for the early diagnosis of tuberculous pleural effusion.
引文
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[2] MEHTA A A,GUPTA A S,AHMED S,et al.Diagnostic utility of adenosine deaminase in exudative pleural effusions[J].Lung India,2014,31(2):142-144.
[3] SUBRAMANI R,DATTA M,SWAMINATHAN S.Does effect of BCG vaccine decrease with time since vaccination and increase tuberculin skin test reaction?[J].Indian J Tuberc,2015,62(4):226-229.
[4] YIN W,TONG Z H,CUI A,et al.PD-1/PD-Ls pathways between CD4+ T cells and pleural mesothelial cells in human tuberculous pleurisy[J].Tuberculosis(Edinb),2014,94(2):131-139.
[5] 中华医学会结核病学分会.肺结核诊断和治疗指南[S].中华结核和呼吸杂志,2001,24(2):70-74.
[6] 余碧芸,周莹艳,邵川,等.结核感染T细胞斑点试验与ADA活性检测对结核性胸腔积液的诊断评价[J].中华医院感染学杂志,2016,26(10):2235-2238.
[7] 李杰,冯源.降钙素原联合腺苷脱氨酶检测对结核性胸腔积液的诊断价值[J].江苏医药,2016,42(14):1553-1555.
[8] 黄迪希,谭守勇,刘志辉.蛋白质组学在结核性胸腔积液诊断中的现状及进展[J].中国防痨杂志,2016,38(3):180-184.
[9] 王玉芝,黄倩,李成文.不同类型T淋巴细胞在结核性胸膜炎发生发展中作用的研究进展[J].山东医药,2017,57(38):103-106.
[10] 王圆圆,贾文青,刘莹.T-SPOT.TB试验对结核性胸腔积液的辅助诊断价值[J].实用医学杂志,2017,33(18):3119-3122.
[11] SHI B,DU X,WANG Q,et al.Increased PD-1 on CD4+CD28- T cell and soluble PD-1 ligand-1 in patients with T2DM:association with atherosclerotic macrovascular diseases[J].Metabolism,2013,62(6):778-785.
[12] GIANCHECCHI E,DELFINO D V,FIERABRACCI A.Recent insights into the role of the PD-1/PD-L1 pathway in immunological tolerance and autoimmunity[J].Autoimmun Rev,2013,12(11):1091-1100.
[13] KR?NIG H,KREMMLER L,HALLER B,et al.Interferon-induced programmed death-ligand 1(PD-L1/B7-H1) expression increases on human acute myeloid leukemia blast cells during treatment[J].Eur J Haematol,2014,92(3):195-203.
[14] SINGH A,MOHAN A,DEY A B,et al.Inhibiting the programmed death 1 pathway rescues Mycobacterium tuberculosis-specific interferon γ-producing T cells from apoptosis in patients with pulmonary tuberculosis[J].J Infect Dis,2013,208(4):603-615.
[15] PAN X,ZHONG A,XING Y,et al.Increased soluble and membrane-bound PD-L1 contributes to immune regulation and disease progression in patients with tuberculous pleural effusion[J].Exp Ther Med,2016,12(4):2161-2168.