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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (8): 846-853.doi: 10.3969/j.issn.1000-6621.2018.08.013

• 论著 • 上一篇    下一篇

结核感染T细胞斑点试验在糖尿病并发肺结核诊断中的价值

王雅,吴妹英,杨坤云,阿尔泰,吴树才,耿书军,李志惠,李明武,康万里(),唐神结()   

  1. 101149 首都医科大学附属北京胸科医院 北京市结核病胸部肿瘤研究所结核病多学科诊疗中心(王雅、唐神结),流行病学研究室(康万里);苏州市第五人民医院(吴妹英);湖南省胸科医院结核科(杨坤云);新疆维吾尔自治区胸科医院科教科(阿尔泰);河北省胸科医院(吴树才、耿书军、李志惠);云南省昆明市第三人民医院结核科(李明武)
  • 收稿日期:2018-04-17 出版日期:2018-08-10 发布日期:2018-09-09
  • 通信作者: 王雅,康万里,唐神结 E-mail:kangwlchch@163.com;tangsj1106@vip.sina.com

The diagnostic value of T cell enzyme-linked immunospot tuberculosis assay in diabetes complicated with pulmonary tuberculosis

Ya WANG,Mei-ying WU,Kun-yun YANG, ,Shu-cai WU,Shu-jun GENG,Zhi-hui LI,Ming-wu LI,Wan-li KANG(),Shen-jie TANG()   

  1. *Tuberculosis Multi-Disciplinary Diagnosis and Treatment Centre, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China
  • Received:2018-04-17 Online:2018-08-10 Published:2018-09-09
  • Contact: Ya WANG,Wan-li KANG,Shen-jie TANG E-mail:kangwlchch@163.com;tangsj1106@vip.sina.com

摘要:

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)对糖尿病并发肺结核患者的诊断价值。方法 回顾性分析了2012年12月至2015年11月在北京胸科医院、苏州市第五人民医院、湖南省胸科医院、新疆维吾尔自治区胸科医院、河北省胸科医院、昆明市第三人民医院结核科住院的207例糖尿病并发肺结核及95例单纯糖尿病患者临床资料,其中糖尿病并发培养阳性肺结核患者组141例(简称“Ⅰ组”)、糖尿病并发培养阴性肺结核患者组(简称“Ⅱ组”)66例、单纯糖尿病患者组(简称“Ⅲ组”)95例。应用全血T-SPOT.TB 试剂盒检测外周血淋巴细胞对MTB菌株早期分泌性靶抗原6(ESAT-6)和培养滤液蛋白10(CFP-10)的免疫反应。结果 T-SPOT.TB检测在Ⅰ组、Ⅱ组、Ⅲ组患者中的阳性率分别为92.9%(131/141) (95%CI:87.3%~96.5%)、86.4% (57/66)(95%CI:75.7%~93.6%)、48.4% (46/95)(95%CI:38.0%~58.9%)。Ⅰ组的T-SPOT.TB检测阳性率高于Ⅲ组,差异有统计学意义(χ 2=59.91,P<0.01);Ⅱ组的T-SPOT.TB检测阳性率高于Ⅲ组,差异有统计学意义(χ 2=24.33,P<0.01)。Ⅰ组的T-SPOT.TB检测阳性率与Ⅱ组接近,差异无统计学意义(χ 2=2.31,P=0.129)。以肺结核临床诊断为金标准,T-SPOT.TB检测糖尿病并发肺结核的敏感度、特异度、阳性预测值、阴性预测值、诊断准确度分别为90.8%(188/207) (95%CI:86.0%~94.3%)、51.6%(49/95) (95%CI:41.1%~62.0%)、80.3%(188/234) (95%CI:74.7%~85.2%)、72.1%(49/68) (95%CI:59.9%~82.3%)、78.5%(237/302) (95%CI:73.4%~83.0%)。结论 T-SPOT.TB检测糖尿病并发肺结核具有较高的阳性率、敏感度和特异度,可以作为糖尿病并发肺结核的一种辅助诊断方法。

关键词: 结核, 肺, 糖尿病, 共病现象, 实验室技术和方法, 酶联免疫斑点检测

Abstract:

Objective To investigate the diagnostic value of T cell enzyme-linked immunospot tuberculosis assay (T-SPOT.TB) in diabetic patients complicated with pulmonary tuberculosis.Methods From December 2012 to November 2015, 207 cases of diabetes mellitus complicated with pulmonary tuberculosis and 95 cases of diabetes in Beijing Chest Hospital, Suzhou Fifth People’s Hospital, Hunan Thoracic Hospital, the Xinjiang Uygur Autonomous Region Thoracic Hospital, Hebei Provincial Chest Hospital, and Kunming Third People’s Hospital tuberculosis department were retrospectively analyzed. Among them, there were 141 cases of diabetes complicated with positive culture pulmonary tuberculosis (group Ⅰ) and 66 cases of diabetes complicated with culture-negative pulmonary tuberculosis (group Ⅱ), and the 95 cases of diabetes were defined as (group Ⅲ). Whole blood T-SPOT.TB kit was used to detect the immune response of peripheral blood lymphocytes to early secretory target antigen 6 (ESAT-6) and secretory protein 10 (CFP-10) of MTB strain.Results The positive rates of T-SPOT.TB in group Ⅰ, Ⅱ and Ⅲ were 92.9% (131/141) (95%CI: 87.3%-96.5%), 86.4% (57/66) (95%CI: 75.7%-93.6%) and 48.4% (46/95) (95%CI: 38.0%-58.9%), respectively. The positive rate of T-SPOT.TB in group Ⅰ was significantly higher than that in group Ⅲ, and the difference was statistically significant (χ 2=59.91 P<0.01); the positive rate of T-SPOT.TB in group Ⅱ was significantly higher than that in group Ⅲ, and the difference was statistically significant (χ 2=24.33, P<0.01); the positive rate of T-SPOT.TB in group Ⅰ was similar to that in group Ⅱ (χ 2=2.31, P=0.129). Taking the clinical diagnosis of pulmonary tuberculosis as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of T-SPOT.TB test to diagnose pulmonary tuberculosis in patients who were complicated with diabetes were 90.8% (188/207) (95%CI: 86.0%-94.3%), 51.6% (49/95) (95%CI: 41.1%-62.0%), 80.3% (188/234) (95%CI: 74.7%-85.2%), 72.1% (49/68) (95%CI: 59.9%-82.3%), and 78.5% (237/302) (95%CI: 73.4%-83.0%), respectively.Conclusion T-SPOT.TB has a high positive rate, sensitivity and specificity in the diagnosis of tuberculosis in diabetes patients complicated with pulmonary tuberculosis. It can be used as an auxiliary diagnostic method for diabetes complicated with pulmonary tuberculosis.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Laboratory techniques and procedures, Enzyme-linked immunospot assay