结核感染T细胞斑点试验对使用免疫抑制剂患者并发肺结核的诊断价值

doi:10.3969/j.issn.1000-6621.2018.09.009

摘要/Abstract

摘要：

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)对使用免疫抑制剂患者并发肺结核的诊断价值。方法收集2013年7月至2015年12月广州市胸科医院收治的197例使用免疫抑制剂并发肺结核患者(简称“观察组”),及同期住院的200例未使用免疫抑制剂的肺结核患者(简称“对照组”)作为研究对象。所有患者均通过痰液或支气管灌洗液(BALF)的涂片或培养查找抗酸杆菌,对阳性菌株行菌种鉴定以排除非结核分枝杆菌,结合胸部X线摄影检查符合活动性肺结核表现,肺结核诊断均符合《肺结核诊断和治疗指南》标准。比较两组患者血T-SPOT.TB、抗酸杆菌金胺O荧光染色涂片镜检(简称“金胺O涂片镜检”)、BACTEC MGIT 960液体培养(简称“MGIT 960”),以及结核菌素纯蛋白衍生物试验(PPD试验)检测阳性率的差异。采用SPSS 19.0软件对计数资料进行χ ²检验,以P<0.05为差异有统计学意义。结果观察组与对照组患者的血T-SPOT.TB检测阳性率[分别为85.28%(168/197)、96.00%(192/200)]均明显高于金胺O涂片镜检[36.55%(72/197)、35.50%(71/200)](χ ²值分别为98.24、162.53,P值均=0.000),MGIT 960 [53.81%(106/197),57.50%(115/200)](χ ²值分别为46.06、83.06,P值均=0.000),PPD试验[34.52%(68/197),63.50%(127/200)](χ ²值分别为105.66、65.40,P值均=0.000)。观察组患者T-SPOT.TB、PPD试验检测阳性率均明显低于对照组(χ ²值分别为13.50、33.36,P值均=0.000)。结论在使用免疫抑制剂患者并发肺结核时采用血T-SPOT.TB技术进行检测仍具有较高的阳性率,较传统的检测方法具有更高的辅助诊断价值。

关键词: 结核, 肺, 免疫抑制剂, 酶联免疫斑点检测, 实验室技术和方法, 对比研究

Abstract:

Objective To explore the diagnostic value of T-SPOT.TB test in detection of pulmonary tuberculosis (PTB) among the patients receiving immuno-suppressive agents.Methods A total of 197 patients, who stayed at the inpatients department of Guangzhou Chest Hospital for receiving immunosuppressive agents treatment from Jul. 2013 to Dec. 2015 and were also diagnosed to be complicated with PTB, were enrolled in this study as the “Observation group”, while 200 PTB cases who stayed at the inpatients department of the same hospital at the same period were enrolled as the “Control group”. All enrolled patients were acid-fast bacillus (AFB) smear microscopy or culture positive with the specimens of their sputum or bronchoalveolar lavage fluid (BALF); in order to exclude NTB, the identification of Mycobacterium tuberculosis (MTB) was performed to culture positive isolates; the images of their chest X-rays were also consistent with the features of active PTB. The diagnosis of PTB for all enrolled patients was consistent with the standards of the Guideline for Pulmonary Tuberculosis Diagnosis and Treatment. The following test results (positive rate) between the two groups were compared: T-SPOT.TB test, AFB fluorescence stain microscopy of Auramine O, BACTEC MGIT 960 liquid culture (MGIT 960) and purified protein derivate (PPD) skin test. SPSS 19.0 software was used for calculation of χ ² test and P<0.05 was regarded as statistical significance. Results The positive rate of T-SPOT.TB was 85.28% (168/197) in the Observation group and 96.00% (192/200) in the Control group respectively; which was significantly higher than that of AFB fluorescence stain microscopy of Auramine O (36.55% (72/197) in the Observation group and 35.50% (71/200) in the Control group; χ ² was 98.24 in the Observation group and 162.53 in the Control group respectively (Ps=0.000)). The positive rates of T-SPOT.TB in the two groups were significantly higher than those of MGIT 960 culture (53.81% (106/197) in the Observation group and 57.50% (115/200) in the Control group; χ ² was 46.06 in the Observation group and 83.06 in the Control group respectively (P=0.000 in both groups). The positive rates of T-SPOT.TB test in both groups were significantly higher than those of PPD skin test (34.52% (68/197) in the Observation group and 63.50% (127/200) in the Control group; χ ² was 105.66 in the Observation group and 65.40 in the Control group respectively (P=0.000 in both groups)). The positive rates of T-SPOT.TB and PPD skin test in the Observation group were significantly lower than those in the Control group (the former χ ² was 13.50 (P=0.000) and the later χ ² was 33.36 (P=0.000)).Conclusion The positive rate of T-SPOT.TB test in those patients receiving immunosuppressive agents and are complicated with PTB is high. The T-SPOT.TB test, as an auxiliary diagnostic method of PTB, is more valuable than those traditional methods.

Key words: Tuberculosis, pulmonary, Immunosuppressive agents, Enzyme-linked immunospot assay, Laboratory techniques and procedures, Comparative study

谭毅刚,李嫣红,郑闽莉. 结核感染T细胞斑点试验对使用免疫抑制剂患者并发肺结核的诊断价值[J]. 中国防痨杂志, 2018, 40(9): 954-958. doi: 10.3969/j.issn.1000-6621.2018.09.009

Yi-gang TAN,Yan-hong LI,Min-li ZHENG. Diagnostic value of T-SPOT.TB method in detection of pulmonary tuberculosis in patients receiving immuno-suppression[J]. Chinese Journal of Antituberculosis, 2018, 40(9): 954-958. doi: 10.3969/j.issn.1000-6621.2018.09.009

图/表 1

参考文献 18

[1]	张琳, 任俊杰, 黄戈 . 免疫抑制剂相关肺结核的临床特点及X线表现. 临床放射学杂志, 2007,26(7):679-682. doi: 10.3969/j.issn.1001-9324.2007.07.010 URL
[2]	谢青, 王德杭 . 免疫低下患者肺结核的CT特征研究. 中国医学计算机成像杂志, 2010,16(4):299-302.
[3]	周新华 . 重视肺结核及其并发病变的影像学分析与诊断. 中国防痨杂志, 2017,39(6):552-554. doi: 10.3969/j.issn.1000-6621.2017.06.002 URL
[4]	梁艳, 王兰, 张翠英 , 等. 两种γ干扰素释放试验及PPD试验结果在结核感染诊断中的比较. 中国防痨杂志, 2015,37(7):740-747.
[5]	中华医学会结核病学分会. 肺结核诊断和治疗指南. 中华结核和呼吸杂志, 2001,24(2):70-74.
[6]	中国防痨协会基础专业委员会. 结核病诊断实验室检验规程.北京: 中国教育文化出版社, 2006: 46-65.
[7]	左晓霞 . 结缔组织疾病患者结核感染的研究现状与思考. 中华风湿病学杂志, 2009,13(10):657-659. doi: 10.3760/cma.j.issn.1007-7480.2009.10.001 URL
[8]	章璐, 王冬雪, 马丽 , 等. 系统性红斑狼疮伴结核分枝杆菌感染42例临床分析. 中华内科杂志, 2008,47(10):808-810.
[9]	钟一鸣, 谷秀梅, 刘文恩 , 等. 结核感染T细胞斑点实验在结缔组织病患者中辅助诊断结核感染的应用. 中华检验医学杂志, 2014,37(2):132-135. doi: 10.3760/cma.j.issn.1009-9158.2014.02.014 URL
[10]	李同心, 何瑛, 周刚 , 等. 全血γ-干扰素释放试验在结核病辅助诊断中的价值. 中国防痨杂志, 2016,38(8):623-629. doi: 10.3969/j.issn.1000-6621.2016.08.005 URL
[11]	任斐, 岳英, 苗风济 , 等. γ-干扰素释放试验对活动性肺结核的诊断价值. 山西医科大学学报, 2015,46(3):252-255.
[12]	Leidl L, Mayanja-Kizza H, Sotgiu G , et al. Relationship of immunodiagnostic assays for tuberculosis and numbers of circulating CD4 + T-cells in HIV infection . Eur Respir J, 2010,35(3):619-626. doi: 10.1183/09031936.00045509 URL
[13]	Yang CH, Chan PC, Liao ST , et al. Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population. PLoS One, 2013,8(8):e73069. doi: 10.1371/journal.pone.0073069 URL
[14]	沈圆兵, 王会芳, 徐亮 , 等. 全血γ-干扰素释放试验对结核病的诊断价值. 国际呼吸杂志, 2016,36(20):1535-1538.
[15]	Pai M, Denkinger CM, Kik SV , et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev, 2014,27(1):3-20. doi: 10.1128/CMR.00034-13 URL
[16]	Trajman A, Steffen RE, Menzies D . Interferon-Gamma Release Assays Versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med, 2013,2013:601737.
[17]	王兴亮, 刘娟, 费忠亭 . 全血γ-干扰素释放试验在继发性肺结核中的辅助诊断价值. 中国防痨杂志, 2015,37(7):764-767. doi: 10.3969/j.issn.1000-6621.2015.07.010 URL
[18]	孟苏凯, 吴振萍, 钟达 . 全血γ-扰素释放试验在诊断结核分枝杆菌感染中的应用价值. 中国防痨杂志, 2015,37(12):1217-1220. doi: 10.3969/j.issn.1000-6621.2015.12.009 URL

组别	T-SPOT.TB		金胺O涂片镜检		χ²值^a	P值^a	MGIT 960培养		χ²值^a	P值^a	PPD试验		χ²值^a	P值^a
组别	阳性	阴性	阳性	阴性	χ²值^a	P值^a	阳性	阴性	χ²值^a	P值^a	阳性	阴性	χ²值^a	P值^a
观察组 (197例)	168 (85.28)	29 (14.72)	72 (36.55)	125 (63.45)	98.24	0.000	106 (53.81)	91 (46.19)	46.06	0.000	68 (34.52)	129 (65.48)	105.66	0.000
对照组 (200例)	192 (96.00)	8 (4.00)	71 (35.50)	129 (64.50)	162.53	0.000	115 (57.50)	85 (42.50)	83.06	0.000	127 (63.50)	73 (36.50)	65.40	0.000
χ²值^b	13.50		0.05		-	-	0.55		-	-	33.36		-	-
P值^b	0.000		0.835		-	-	0.480		-	-	0.000		-	-