中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2012年
4期
221-224
,共4页
陶学芳%王华钧%王建华%钟建平%李永兴
陶學芳%王華鈞%王建華%鐘建平%李永興
도학방%왕화균%왕건화%종건평%리영흥
结核,肺%干扰素γ%酶联免疫斑点检测%治疗结果
結覈,肺%榦擾素γ%酶聯免疫斑點檢測%治療結果
결핵,폐%간우소γ%매련면역반점검측%치료결과
Tuberculosis,pulmonary%Interferon-γ%Enzyme-linked immunospot assay%Treatment outcome
目的 探讨基于γ-干扰素释放的T细胞斑点试验( T-SPOT.TB)对诊断肺结核及评价抗结核疗效的意义.方法 采用T-SPOT.TB检测55例活动性肺结核患者、14例肺部病变非肺结核患者和12名健康体检者外周血特异性T细胞释放IFNγ的斑点形成细胞数(SFC),并对20例痰菌及T-SPOT.TB均阳性的活动性肺结核患者在治疗前、治疗第2个月末和第6个月末分别行T-SPOT.TB检测.多组间的比较采用多个独立样本Kruskal-Wallis H检验,组间两两比较采用Mann-Whitney U检验,治疗前后SFC数值差异比较采用Wilcoxon符号秩检验.结果 肺结核组T-SPOT.TB阳性率(85.5％,47/55)显著高于肺部疾病组(2/14)和健康对照组(1/12)(x2 =40.926,P＜0.05).肺结核组T-SPOT.TB的早期分泌抗原(ESAT-6)孔(A孔)和培养滤过蛋白(CFP-10)孔(B孔)SFC分别为70.00(27.00～125.00)和80.00(17.00～ 180.00),显著高于肺部疾病组和健康对照组,差异具有统计学意义(x2 =35.376和30.485,P值均＜0.05).T-SPOT.TB诊断菌阳和菌阴肺结核的敏感度、特异度、阳性预测值和阴性预测值分别为88.6％和80.0％,88.5％和88.5％,91.2％和84.2％,85.0％和85.2％,差异无统计学意义(P＞0.05).痰菌及T-SPOT.TB均阳性的20例活动性肺结核患者治疗前测试孔A和孔B的SFC分别为75.50(41.25 ～116.25)和56.25(105.00～225.00),治疗2个月的测试孔A和孔B的SFC分别为41.0(18.00～68.75)和72.50(42.25～158.75),较治疗前下降(Z=-3.213和- 3.622,P值均＜0.05)；治疗6个月末,测试孔A和B的SFC分别为25.00( 5.75～52.25)和55.00(6.25 ～ 122.50),较治疗前明显下降(Z=-3.921和-3.923,P＜0.05),较治疗2个月时下降差异也有统计学意义(Z=-3.926和-3.884,P＜0.05).结论 T-SPOT.TB对诊断结核分枝杆菌感染及监测抗结核治疗疗效上有重要意义,且对痰菌阴性肺结核具有重要的诊断价值.
目的 探討基于γ-榦擾素釋放的T細胞斑點試驗( T-SPOT.TB)對診斷肺結覈及評價抗結覈療效的意義.方法 採用T-SPOT.TB檢測55例活動性肺結覈患者、14例肺部病變非肺結覈患者和12名健康體檢者外週血特異性T細胞釋放IFNγ的斑點形成細胞數(SFC),併對20例痰菌及T-SPOT.TB均暘性的活動性肺結覈患者在治療前、治療第2箇月末和第6箇月末分彆行T-SPOT.TB檢測.多組間的比較採用多箇獨立樣本Kruskal-Wallis H檢驗,組間兩兩比較採用Mann-Whitney U檢驗,治療前後SFC數值差異比較採用Wilcoxon符號秩檢驗.結果 肺結覈組T-SPOT.TB暘性率(85.5％,47/55)顯著高于肺部疾病組(2/14)和健康對照組(1/12)(x2 =40.926,P＜0.05).肺結覈組T-SPOT.TB的早期分泌抗原(ESAT-6)孔(A孔)和培養濾過蛋白(CFP-10)孔(B孔)SFC分彆為70.00(27.00～125.00)和80.00(17.00～ 180.00),顯著高于肺部疾病組和健康對照組,差異具有統計學意義(x2 =35.376和30.485,P值均＜0.05).T-SPOT.TB診斷菌暘和菌陰肺結覈的敏感度、特異度、暘性預測值和陰性預測值分彆為88.6％和80.0％,88.5％和88.5％,91.2％和84.2％,85.0％和85.2％,差異無統計學意義(P＞0.05).痰菌及T-SPOT.TB均暘性的20例活動性肺結覈患者治療前測試孔A和孔B的SFC分彆為75.50(41.25 ～116.25)和56.25(105.00～225.00),治療2箇月的測試孔A和孔B的SFC分彆為41.0(18.00～68.75)和72.50(42.25～158.75),較治療前下降(Z=-3.213和- 3.622,P值均＜0.05)；治療6箇月末,測試孔A和B的SFC分彆為25.00( 5.75～52.25)和55.00(6.25 ～ 122.50),較治療前明顯下降(Z=-3.921和-3.923,P＜0.05),較治療2箇月時下降差異也有統計學意義(Z=-3.926和-3.884,P＜0.05).結論 T-SPOT.TB對診斷結覈分枝桿菌感染及鑑測抗結覈治療療效上有重要意義,且對痰菌陰性肺結覈具有重要的診斷價值.
목적 탐토기우γ-간우소석방적T세포반점시험( T-SPOT.TB)대진단폐결핵급평개항결핵료효적의의.방법 채용T-SPOT.TB검측55례활동성폐결핵환자、14례폐부병변비폐결핵환자화12명건강체검자외주혈특이성T세포석방IFNγ적반점형성세포수(SFC),병대20례담균급T-SPOT.TB균양성적활동성폐결핵환자재치료전、치료제2개월말화제6개월말분별행T-SPOT.TB검측.다조간적비교채용다개독립양본Kruskal-Wallis H검험,조간량량비교채용Mann-Whitney U검험,치료전후SFC수치차이비교채용Wilcoxon부호질검험.결과 폐결핵조T-SPOT.TB양성솔(85.5％,47/55)현저고우폐부질병조(2/14)화건강대조조(1/12)(x2 =40.926,P＜0.05).폐결핵조T-SPOT.TB적조기분비항원(ESAT-6)공(A공)화배양려과단백(CFP-10)공(B공)SFC분별위70.00(27.00～125.00)화80.00(17.00～ 180.00),현저고우폐부질병조화건강대조조,차이구유통계학의의(x2 =35.376화30.485,P치균＜0.05).T-SPOT.TB진단균양화균음폐결핵적민감도、특이도、양성예측치화음성예측치분별위88.6％화80.0％,88.5％화88.5％,91.2％화84.2％,85.0％화85.2％,차이무통계학의의(P＞0.05).담균급T-SPOT.TB균양성적20례활동성폐결핵환자치료전측시공A화공B적SFC분별위75.50(41.25 ～116.25)화56.25(105.00～225.00),치료2개월적측시공A화공B적SFC분별위41.0(18.00～68.75)화72.50(42.25～158.75),교치료전하강(Z=-3.213화- 3.622,P치균＜0.05)；치료6개월말,측시공A화B적SFC분별위25.00( 5.75～52.25)화55.00(6.25 ～ 122.50),교치료전명현하강(Z=-3.921화-3.923,P＜0.05),교치료2개월시하강차이야유통계학의의(Z=-3.926화-3.884,P＜0.05).결론 T-SPOT.TB대진단결핵분지간균감염급감측항결핵치료료효상유중요의의,차대담균음성폐결핵구유중요적진단개치.
Objective To evaluate the application of interferon-γ release assay T-SPOT.TB in diagnosis and efficacy assessment of pulmonary tuberculosis. Methods T-SPOT.TB assay was used to determine spot-forming cells (SFCs) formed by T-cells when stimulated by Mycobacterium tuberculosisspecific antigens in 55 patients with active tuberculosis,14 patients with non-tuberculosis lung diseases and 12 healthy controls. Meanwhile 20 sputum culture-positive and qualitative assay-positive pulmonary tuberculosis patients were tested with T-SPOT.TB before and at 2-month and 6-month after treatment.Kruskal-Wallis H and Mann-Whitney U test were used in group comparison.Wilcoxon test was used in comparison between pre- and post-treatment.Results The positive rate of T-SPOT.TB was significantly higher in patients with tuberculosis (85.5％,47/55 ) than that in patients with non-tuberculosis lung diseases (2/14) and the healthy controls (1/12) (x2 =40.926,P ＜0.05).The SFCs of hole A in response to ESAT-6 and hole B in response to CFP-10 in pulmonary tuberculosis group were 70.00 (27.00 -125.00) and 80.00 ( 17.00 - 180.00),respectively,which were all significantly higher than those in nontuberculosis lung diseases group and the healthy controls (x2 =35.376 and 30.485,P ＜ 0.05 ).The sensitivity,specificity,positive predictive value and negative predictive value of T-SPOT.TB in diagnosis of smear-positive tuberculosis were 88.6％,88.5％,91.2％ and 85％,while in diagnosis of sputum smearnegative tuberculosis,the sensitivity was 80％,specificity was 88.5％,positive predictive value was 84.2％ and negative predictive value was 85.2％ ( P ＞ 0.05 ).SFCs of hole A and hole B in 20 patients with sputum culture-positive and qualitative assay-positive pulmonary tuberculosis were 75.50 (41.25 -116.25 ) and 56.25 ( 105.00 -225.00) before the treatment.After 2-month antituberculosis treatment,the SFCsofhole A and hole B were 41.0 (18.0-68.75) and 72.50 (42.25- 158.75),which were significantly lower than those before treatment (Z =- 3.213 and - 3.622,P ＜ 0.05 ).Ater 6-month antituberculosis treatment,the SFCs of hole A and hole B were 25.00 (5.75 - 52.25) and 55.00 (6.25 -122.50),which were significantly lower than those before and 2-month after antituberculosis treatment (vs.before treatment:Z =- 3.921 and - 3.923,P ＜ 0.05 ; vs.2-month antituberculosis treatment:Z =- 3.926 and - 3.884,P ＜ 0.05 ).Conclusions T-SPOT.TB assay possess satisfactory sensitivity and specificity in diagnosis of tuberculosis infection,especially for sputum-negative pulmonary tuberculosis.It is also of value in monitoring antituberculosis treatment.
