T-SPOT中TBAg/PHA比值在结核病诊断中的应用价值
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摘要
目的探讨结核分枝杆菌特异性抗原(TBAg)/植物凝集素(PHA)比值诊断活动性结核病(ATB)、潜伏性结核病(LTBI)及陈旧性结核病(OTB)的应用价值。方法选取2016年10月至2017年6月该院收治的住院且T细胞斑点试验(T-SPOT)检测均为阳性的结核病患者191例,其中确诊为ATB患者101例,LTBI患者84例,OTB患者6例。采用T-SPOT试验对2种TBAg进行检测,包括早期分泌靶抗原-6(ESAT-6)和培养滤液蛋白-10(CFP-10)。统计ESAT-6、CFP-10和PHA形成的斑点数(sfc),计算ESAT-6/PHA比值和CFP-10/PHA比值,其中比值大者定义为TBAg/PHA比值并纳入统计分析。结果 ATB组患者PHA sfc显著低于LTBI组和OTB组,TBAg/PHA比值显著高于LTBI组和OTB组,差异均有统计学意义(P<0.05);以TBAg/PHA比值为0.279 8作为区分ATB和LTBI的临界值,灵敏度和特异性分别达82.00%和91.67%。结论 TBAg/PHA比值可用于诊断ATB,且在鉴别ATB和LTBI方面具有较好的临床应用价值。
Objective To explore the diagnostic value of mycobacterium tuberculosis specific antigen(TBAg)/phytagglutinin(PHA)ratio in active tuberculosis(ATB),latent tuberculosis(LTBI)and old tuberculosis(OTB).Methods 191 tuberculosis patients admitted to our hospital from October 2016 to June 2017 with positive T-SPOT test were selected.Among them,101 patients were diagnosed as ATB,84 patients with LTBI and 6 patients with OTB.Two kinds of TBAg were detected by T-SPOT test,including early secretion target antigen-6(ESAT-6)and culture filtrate protein-10(CFP-10).Spot counts(sfc)formed by ESAT-6,CFP-10 and PHA were counted.ESAT-6/PHA ratio and CFP-10/PHA ratio were calculated.The larger ratio was defined as TBAg/PHA ratio and included in the statistical analysis.Results In the ATB group,sfc of PHA was decreased significantly comparing to LTBI group and OTB group.The TBAg/PHA ratio in ATB group was significantly higher than that in LTBI and OTB group,and the differences were statistically significant(P<0.05).The sensitivity and specificity were 82.00%and 91.67%respectively when the TBAg/PHA ratio was 0.279 8 as the critical value to distinguish ATB from LTBI.Conclusion The ratio of TBAg/PHA can be used to diagnose ATB,and has good clinical value in identifying ATB and LTBI.
Objective To explore the diagnostic value of mycobacterium tuberculosis specific antigen(TBAg)/phytagglutinin(PHA)ratio in active tuberculosis(ATB),latent tuberculosis(LTBI)and old tuberculosis(OTB).Methods 191 tuberculosis patients admitted to our hospital from October 2016 to June 2017 with positive T-SPOT test were selected.Among them,101 patients were diagnosed as ATB,84 patients with LTBI and 6 patients with OTB.Two kinds of TBAg were detected by T-SPOT test,including early secretion target antigen-6(ESAT-6)and culture filtrate protein-10(CFP-10).Spot counts(sfc)formed by ESAT-6,CFP-10 and PHA were counted.ESAT-6/PHA ratio and CFP-10/PHA ratio were calculated.The larger ratio was defined as TBAg/PHA ratio and included in the statistical analysis.Results In the ATB group,sfc of PHA was decreased significantly comparing to LTBI group and OTB group.The TBAg/PHA ratio in ATB group was significantly higher than that in LTBI and OTB group,and the differences were statistically significant(P<0.05).The sensitivity and specificity were 82.00%and 91.67%respectively when the TBAg/PHA ratio was 0.279 8 as the critical value to distinguish ATB from LTBI.Conclusion The ratio of TBAg/PHA can be used to diagnose ATB,and has good clinical value in identifying ATB and LTBI.
引文
[1] WHO.Global Tuberculosis Control report 2006[R].World Health Orangnization,2006.
[2] YEW WW,LEUNG CC.Update in tuberculosis 2007[J].Am J Respir Crit Care Med,2008,177(5):479-485.
[3] DIEL R,LODDENKEMPER R,NIENHAUS A.Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB:a metaanalysis[J].Chest,2010,137(4):952-968.
[4] PINTO LM,GRENIER J,SCHUMACHER SG,et al.Immunodiagnosis of tuberculosis:state of the art[J].Med Princ Pract,2012,21(1):4-13.
[5] LALVANI A.Diagnosing tuberculosis infection in the21st century:new tools to tackle And old enemy[J].Chest,2007,131(6):1898-1906.
[6]沈彦恒,桂徐蔚,沈芸,等.T细胞斑点检测在鉴别结核分枝杆菌与非结核分枝杆菌感染中的价值[J].中国医刊,2016,51(4):78-81.
[7]黄汉鹏.比较结核感染T细胞斑点试验、结核菌素试验以及血清结核抗体检测对诊断肺结核的价值[J].中外医疗,2016,35(35):41-42.
[8]钟华清,徐梦华,卢丽娟,等.干扰素-γ释放试验在儿童结核感染中的应用价值[J].检验医学,2016,31(3):176-179.
[9]童学成,陈国春,濮翔科,等.结核感染T细胞斑点试验对艾滋病合并肺结核的临床诊断价值[J].中华医院感染学杂志,2014,24(14):3632-3634.
[10]Campainha S,Gomes T,Carvalho A,et al.Negative predictive value of TST and IGRA in anti-TNF treated patients[J].Eur Respir J,2012,40(3):790-791.
[11]霍霏霏,张丽帆,刘晓清.评价γ干扰素释放分析TSPOT.TB在肺外结核病诊断中的敏感性[J].中国医学科学院学报,2009,31(4):449-452.
[12]向瑜,杨捷,张莉萍.T细胞斑点试验反应强度在诊断活动性结核病中的价值[J].中国微生态学杂志,2016,28(12):1456-1459.
[13]AMANATIDOU V,SYRIDOU G,MAVRIKOU M,et al.Latent tuberculosis infection in children:diagnostic approaches[J].Eur J Clin Microbiol Infect Dis,2012,31(7):1285-1294.
[14]JANSSENS JP,ROUX-LOMBARD P,PERNEGER T,et al.Quantitative scoring of an interferon-gamma assay for differentiating active from latent tuberculosis[J].Eur Respir J,2007,30(4):722-728.
[15]CHEN X,ZHOU B,LI M,et al.CD4(+)CD25(+)FoxP3(+)regulatory T cells suppress Mycobacterium tuberculosisimmunity in patients with active disease[J].Clin Immunol,2007.123(1):50-59.
[16]METCALFE JZ,CATTAMANCHI A,VITTINGHOFF E,et al.Evaluation of quantitative IFN-gamma response for risk stratification of active tuberculosis suspects[J].Am J Respir Crit Care Med,2010,181(1):87-93.
[2] YEW WW,LEUNG CC.Update in tuberculosis 2007[J].Am J Respir Crit Care Med,2008,177(5):479-485.
[3] DIEL R,LODDENKEMPER R,NIENHAUS A.Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB:a metaanalysis[J].Chest,2010,137(4):952-968.
[4] PINTO LM,GRENIER J,SCHUMACHER SG,et al.Immunodiagnosis of tuberculosis:state of the art[J].Med Princ Pract,2012,21(1):4-13.
[5] LALVANI A.Diagnosing tuberculosis infection in the21st century:new tools to tackle And old enemy[J].Chest,2007,131(6):1898-1906.
[6]沈彦恒,桂徐蔚,沈芸,等.T细胞斑点检测在鉴别结核分枝杆菌与非结核分枝杆菌感染中的价值[J].中国医刊,2016,51(4):78-81.
[7]黄汉鹏.比较结核感染T细胞斑点试验、结核菌素试验以及血清结核抗体检测对诊断肺结核的价值[J].中外医疗,2016,35(35):41-42.
[8]钟华清,徐梦华,卢丽娟,等.干扰素-γ释放试验在儿童结核感染中的应用价值[J].检验医学,2016,31(3):176-179.
[9]童学成,陈国春,濮翔科,等.结核感染T细胞斑点试验对艾滋病合并肺结核的临床诊断价值[J].中华医院感染学杂志,2014,24(14):3632-3634.
[10]Campainha S,Gomes T,Carvalho A,et al.Negative predictive value of TST and IGRA in anti-TNF treated patients[J].Eur Respir J,2012,40(3):790-791.
[11]霍霏霏,张丽帆,刘晓清.评价γ干扰素释放分析TSPOT.TB在肺外结核病诊断中的敏感性[J].中国医学科学院学报,2009,31(4):449-452.
[12]向瑜,杨捷,张莉萍.T细胞斑点试验反应强度在诊断活动性结核病中的价值[J].中国微生态学杂志,2016,28(12):1456-1459.
[13]AMANATIDOU V,SYRIDOU G,MAVRIKOU M,et al.Latent tuberculosis infection in children:diagnostic approaches[J].Eur J Clin Microbiol Infect Dis,2012,31(7):1285-1294.
[14]JANSSENS JP,ROUX-LOMBARD P,PERNEGER T,et al.Quantitative scoring of an interferon-gamma assay for differentiating active from latent tuberculosis[J].Eur Respir J,2007,30(4):722-728.
[15]CHEN X,ZHOU B,LI M,et al.CD4(+)CD25(+)FoxP3(+)regulatory T cells suppress Mycobacterium tuberculosisimmunity in patients with active disease[J].Clin Immunol,2007.123(1):50-59.
[16]METCALFE JZ,CATTAMANCHI A,VITTINGHOFF E,et al.Evaluation of quantitative IFN-gamma response for risk stratification of active tuberculosis suspects[J].Am J Respir Crit Care Med,2010,181(1):87-93.