抗结核抗体及结核感染T细胞斑点试验在结核病诊断中的应用

摘要/Abstract

摘要： 目的探讨抗结核抗体(38kD-IgG)及结核感染T细胞斑点试验（T SPOT-TB）在结核病临床诊断中的价值。方法以上述2种方法单项及联合检测活动性结核病患者83例（菌阳结核患者43例，菌阴结核患者40例），非结核对照者50例（其中有呼吸系统疾病者15例，健康查体者35例），共计133例。结果38kD-IgG及T SPOT-TB试验检测菌阳结核的阳性率分别为79.1%和93.0%，联合检测阳性率为97.7%;2种方法单项检测菌阴结核的阳性率均为72.5%，联合检测阳性率提高到92.5%。50名非结核对照中，2种试验特异性分别为70.0％和94.0%，联合检测特异性为66.0％。结论对于菌阳患者，T SPOT-TB试验敏感性较高（93.0%），但与38kD-IgG方法相比，统计学上差异无统计学意义（χ²=3.49, P>0.05）；T SPOT-TB试验的特异性明显高于38kD-IgG试验（χ²=9.76, P<0.01）；2种方法联合检测能显著提高菌阴结核患者阳性检出率，与单项检测方法相比，差别有统计学意义（χ²=5.54, P<0.05）因此，联合检测对于菌阴结核患者的诊断,具有实用价值。

关键词: 结核/诊断, 抗体, 细菌, 免疫球蛋白G, 免疫酶技术

Abstract: ObjectiveTo evaluate the application value of tuberculosis antibody and enzyme-linked immuno-spot assay used for Clinical diagnosis of TB.MethodsThe two Methods were used individually and in combination respectively to 83 active tuberculosis patients (43 Mycobacterial tuberculosis positive patients, 40 Mycobacterial tuberculosis negative patients), 50 nontuberculosis in control group.ResultsMycobacterium positive rate were 79％detected with 38kD-IgG and 93.0％ with T SPOT-TB． The combined detection positive rate was 97.7％． The TB culture negative patient’s Mycobacterium positive rate were both 72.5％ tested with the two single method． And the combined tested positive rate was 92.5％． To Non-TB control group, the specificity rate of the 2 Methods were 70.0％ and 94.0％ respectively. Combined tested specificity rate was 66％． ConclusionsTo TB positive patients， T Spot-TB is more sensitivity than 38kD-IgG (93％)． But there was no significantly statistical difference (χ²=3.49， P>0.05) between them． T SPOT-TB test specificity was significantly higher than 38kD-IgG test (χ²=9.76，P<0.01)． Joint detection of the two Methods can significantly improve the tuberculosis positive rate in culture negative patients． Compared with the single detection method， the difference was statistically significant (χ²=5.54，P<0.05)， As a result， the joint testing for TB-negative patients have more practical value.

Key words: tuberculosis/diagnosis, antibodies,bacterial, immunoglobulin G, immunoenzyme techniques

赵静,蒋彩花,汪运山,王海英. 抗结核抗体及结核感染T细胞斑点试验在结核病诊断中的应用[J]. 中国防痨杂志, 2009, 31(1): 19-21.

Zhao Jing¹，Jiang Caihua，Wang Yunshan, Wang Haiying.. Evaluate the application value of tuberculosis antibody and enzyme-linked immuno-spot assay used for tuberculosis.[J]. Chinese Journal of Antituberculosis, 2009, 31(1): 19-21.

参考文献

[1] Meier T, Eulenbruch HP, Wrighton-Smith P, et al. Sensitivity of a new commercial enzyme-linked immunospot assay (T SPOT-TB) for diagnosis of tuberculosis in clinical practice[J]. Eur J Clin Microbiol Infect Dis. 2005,24 (8):529-536.
[2] 乐军，梁莉，李苏辉，等. 酶联免疫斑点试验快速诊断结核分枝杆菌感染的临床应用价值 [J]. 中华检验医学杂志[J]，2006，29（11）：1005－1008.
[3] 中华医学会结核病学分会. 肺结核诊断和治疗指南 [J]. 中华结核和呼吸杂志，2001，24（2）：70－74.
[4] 彭卫生，王英年，肖成志.新编结核病学 [M]. 第二版. 北京：中国医药出版社，2003：104.
[5] Lalvani A, Pathan AA, McShane H，et al. Rapid detection of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells [J]. Am J Respir Crit Care Med， 2001,163(4):824-828.
[6] Dheda K, Pooran A, Pai M,et al. Interpretation of Mycobacterium tuberculosis antigen-specific IFN-gamma release assays (T SPOT-TB) and factors that may modulate test results[J]. J Infect， 2007, 55 (2):169-173.
[7] 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, 2007, 30(6):1173-1179.
[8] Wilkinson KA, Wilkinson RJ, Pathan A,et al. Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis[J]. Clin Infect Dis, 2005, 40(1):184-187.
[9] Chapman AL, Munkanta M, Wilkinson KA, et al. Rapid detection of active and latent tuberculosis infection in HIV-positive individuals by enumeration of Mycobacterium tuberculosis-specific T cells [J]. AIDS, 2002,16(17):2285-2293.
[10] Ewer K, Deeks J, Alvarez L, et al. Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak [J]. Lancet, 2003,361 (9364):1168-1173.

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