结核性胸膜炎合并2型糖尿病患者外周血及胸腔积液结核感染T细胞斑点试验检测结果的对比研究

doi:10.19982/j.issn.1000-6621.20210642

中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (5): 489-493.doi: 10.19982/j.issn.1000-6621.20210642

结核性胸膜炎合并2型糖尿病患者外周血及胸腔积液结核感染T细胞斑点试验检测结果的对比研究

刘媛¹, 剧猛², 左蕾², 张耀辉³, 黄毅²()

¹西安市胸科医院检验科,西安 710100
²西安市胸科医院超声科,西安 710100
³西安市胸科医院医务科统计室,西安 710100

收稿日期:2021-11-08 出版日期:2022-05-10 发布日期:2022-05-04
通信作者: 黄毅 E-mail:huang-yi-1980@163.com
基金资助:
陕西省重点研发项目(2021SF-015);西安市科技计划项目(J201902024)

Comparative study on results of T-cell spot test for tuberculosis infection of peripheral blood and pleural effusion in tuberculous pleurisy patients complicated with type 2 diabetes mellitus

LIU Yuan¹, JU Meng², ZUO Lei², ZHANG Yao-hui³, HUANG Yi²()

¹Department of Clinical Laboratory, Xi’an Chest Hospital, Xi’an 710100, China
²Department of Ultrasonography, Xi’an Chest Hospital, Xi’an 710100, China
³Department of Statistics, Xi’an Chest Hospital, Xi’an 710100, China

Received:2021-11-08 Online:2022-05-10 Published:2022-05-04
Contact: HUANG Yi E-mail:huang-yi-1980@163.com
Supported by:
Key Research and Development Project of Shaanxi Province(2021SF-015);Xi’an Science and Technology Project(J201902024)

摘要/Abstract

摘要：

目的: 探讨合并2型糖尿病对结核性胸膜炎患者外周血及胸腔积液结核感染T细胞斑点试验(T-SPOT.TB)检测结果的影响。方法: 收集2016—2021年西安市胸科医院收治的诊断为结核性胸膜炎的444例患者,依据是否合并2型糖尿病,分为结核性胸膜炎合并2型糖尿病组(合并糖尿病组;116例)和未合并糖尿病的结核性胸膜炎组(非糖尿病组;328例)。分别采集两组患者抗结核药物治疗前胸腔积液和外周血标本,进行T-SPOT.TB检测,分析两组患者T-SPOT.TB检测结果的差异。结果: 合并糖尿病组和非糖尿病组患者外周血T-SPOT.TB检测阳性率分别为46.55%(54/116)和56.10%(184/328),差异无统计学意义(χ²=3.140,P=0.076);胸腔积液T-SPOT.TB检测阳性率分别为65.52%(76/116)和88.41%(290/328),合并糖尿病组明显低于非糖尿病组,差异有统计学意义(χ²=31.025,P<0.001)。合并糖尿病组和非糖尿病组患者胸腔积液T-SPOT.TB检测阳性率均高于外周血,差异均有统计学意义(χ²=4.845,P=0.028;χ²=12.848,P<0.001)。结论: 当结核性胸膜炎患者合并2型糖尿病时,胸腔积液T-SPOT.TB检测阳性率降低,但仍高于外周血T-SPOT.TB检测结果;建议考虑优先行胸腔积液T-SPOT.TB检测,以提高阳性检出率。

关键词: 糖尿病,2型, 结核,胸膜, 共病现象, 酶联免疫吸附测定, 对比研究

Abstract:

Objective: To investigate the effect of type 2 diabetes mellitus on the results of T-cell spot test for tuberculosis infection (T-SPOT.TB) of the peripheral blood and pleural effusion in patients with tuberculous pleurisy. Methods: According to whether complicated with type 2 diabetes mellitus, 444 tuberculous pleurisy patients from Xi’an Chest Hospital between 2016 and 2021 were divided into tuberculous pleurisy complicated with type 2 diabetes mellitus group (n=116) and tuberculous pleurisy without type 2 diabetes mellitus group (n=328). The pleural effusion and peripheral blood specimens of the two groups before medical treatment were collected for T-SPOT.TB, and the results were compared. Results: The positive rates of peripheral blood T-SPOT.TB were 46.55% (54/116) in the tuberculous pleurisy complicated with type 2 diabetes mellitus group and 56.10% (184/328) in the tuberculous pleurisy without type 2 diabetes mellitus group, respectively, and there was no significant difference between the two groups (χ²=3.140, P=0.076). The positive rate of pleural effusion T-SPOT.TB in the tuberculous pleurisy complicated with type 2 diabetes mellitus group was significantly lower than that in the tuberculous pleurisy without type 2 diabetes mellitus group (65.52% (76/116) vs. 88.41% (290/328), χ²=31.025, P<0.001). By T-SPOT.TB, the positive rates in pleural effusion were significantly higher than those in peripheral blood in both two groups (χ²=4.845, P=0.028; χ²=12.848, P<0.001). Conclusion: When tuberculous pleurisy patients complicated with type 2 diabetes mellitus, the positive rate of T-SPOT.TB in pleural effusion was decreased, but it was still higher than that in peripheral blood. Pleural effusion T-SPOT.TB detection was recommended to improve the positive detection rate.

Key words: Diabetes mellitus,type 2, Tuberculosis,pleural, Comorbidity, Enzyme-linked immunosorbent assay, Comparative study

中图分类号:

R52
R446.1

刘媛, 剧猛, 左蕾, 张耀辉, 黄毅. 结核性胸膜炎合并2型糖尿病患者外周血及胸腔积液结核感染T细胞斑点试验检测结果的对比研究[J]. 中国防痨杂志, 2022, 44(5): 489-493. doi: 10.19982/j.issn.1000-6621.20210642

LIU Yuan, JU Meng, ZUO Lei, ZHANG Yao-hui, HUANG Yi. Comparative study on results of T-cell spot test for tuberculosis infection of peripheral blood and pleural effusion in tuberculous pleurisy patients complicated with type 2 diabetes mellitus[J]. Chinese Journal of Antituberculosis, 2022, 44(5): 489-493. doi: 10.19982/j.issn.1000-6621.20210642

图/表 1

表1

合并糖尿病组及非糖尿病组患者一般资料及临床特征的比较

特征	合并糖尿病组(116例)	非糖尿病组(328例)	统计检验值	P值
年龄(岁, $x ¯$ ±s)	58.0±14.5	34.5±16.9	t=13.331	<0.001
性别[例(构成比,%)]			χ²=3.183	0.074
男性	69(59.48)	225(68.60)
女性	47(40.52)	103(31.40)
合并肺结核[例(构成比,%)]			χ²=0.412	0.521
是	95(81.90)	277(84.45)
否	21(18.10)	51(15.55)
肺结核病原学结果[例(构成比,%)]			χ²=0.500	0.480
阳性	70(73.68)	214(77.26)
阴性	25(26.32)	63(22.74)
治疗情况[例(构成比,%)]			χ²=0.744	0.388
初治	83(71.55)	248(75.61)
复治	33(28.45)	80(24.39)
诊断依据[例(构成比,%)]			χ²=3.056	0.080
确诊	93(80.17)	285(86.89)
临床诊断	23(19.83)	43(13.11)

表1

参考文献 20

[1]	Du Q, Wang L, Long Q, et al. Systematic review and meta-analysis: Prevalence of diabetes among patients with tuberculosis in China. Trop Med Int Health, 2021, 26(12):1553-1559. doi: 10.1111/tmi.13686. doi: 10.1111/tmi.13686 URL
[2]	Cheng J, Zhang H, Zhao YL, et al. Mutual Impact of Diabetes Mellitus and Tuberculosis in China. Biomed Environ Sci, 2017, 30(5): 384-389. doi: 10.3967/bes2017.051. doi: 10.3967/bes2017.051 pmid: 28549496
[3]	蔡静. 肺结核合并2型糖尿病流行现状及主要影响因素分析. 青岛: 青岛大学, 2015.
[4]	Koh WJ. Progression of Tuberculous Pleurisy: From a Lymphocyte-Predominant Free-Flowing Effusion to a Neutrophil-Predominant Loculated Effusion. Tuberc Respir Dis (Seoul), 2017, 80(1):90-92. doi: 10.4046/trd.2017.80.1.90. doi: 10.4046/trd.2017.80.1.90 URL
[5]	Zhu F, Ou Q, Zheng J. Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis. Iran J Public Health, 2018, 47(1): 18-23.
[6]	唐怡敏, 张娟娟, 叶涛生, 等. 不同检测指标对早期筛查结核性胸膜炎粘连的价值. 结核病与肺部健康杂志, 2018, 7(4): 298-304. doi: 10.3969/j.issn.2095-3755.2018.04.015. doi: 10.3969/j.issn.2095-3755.2018.04.015
[7]	邹琳琳, 黎友伦. γ-干扰素释放试验在免疫受损合并肺结核患者中的应用. 中国免疫学杂志, 2016, 32(6):878-881.
[8]	中华人民共和国国家卫生和计划生育委员会. WS 288-2017肺结核诊断. 2017-11-09.
[9]	Luo Y, Yan F, Xue Y, et al. Diagnostic utility of pleural fluid T-SPOT and interferon-gamma for tuberculous pleurisy: A two-center prospective cohort study in China. Int J Infect Dis, 2020, 99: 515-521. doi: 10.1016/j.ijid.2020.08.007. doi: 10.1016/j.ijid.2020.08.007 URL
[10]	American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care, 2019, 42(Suppl 1): S13-S28. doi: 10.2337/dc19-S002. doi: 10.2337/dc19-S002
[11]	刘立虎, 吴军, 熊军宁. T细胞斑点试验在肺结核合并糖尿病患者中的诊断价值. 中国当代医药, 2016, 23(21): 134-136, 139.
[12]	刘爱梅, 刘存旭. γ-干扰素释放试验在我国应用的现状与进展. 结核病与肺部健康杂志, 2016, 5(1): 62-68. doi: 10.3969/j.issn.2095-3755.2016.01.017. doi: 10.3969/j.issn.2095-3755.2016.01.017
[13]	Walsh MC, Camerlin AJ, Miles R, et al. The sensitivity of interferon-gamma release assays is not compromised in tuberculosis patients with diabetes. Int J Tuberc Lung Dis, 2011, 15(2): 179-184. pmid: 21219678
[14]	杨牧青, 刘俊刚, 孙芳, 等. 合并糖尿病对肺结核患者T-SPOT.TB阳性率的影响. 河南医学研究, 2018, 27(2): 211-212. doi: 10.3969/j.issn.1004-437X.2018.02.008. doi: 10.3969/j.issn.1004-437X.2018.02.008
[15]	周敏, 杨清銮, 陈华昕, 等. 外周血及胸腔积液γ-干扰素释放试验对结核性胸膜炎的诊断价值. 解放军医学杂志, 2018, 43(1):56-60. doi: 10.11855/j.issn.0577-7402.2018.01.11. doi: 10.11855/j.issn.0577-7402.2018.01.11
[16]	Zhang L, Zhang Y, Shi X, et al. Utility of T-cell interferon-γ release assays for diagnosing tuberculous serositis: a prospective study in Beijing, China. PLoS One, 2014, 9(1): e85030. doi: 10.1371/journal.pone.0085030. doi: 10.1371/journal.pone.0085030 URL
[17]	Barnes PF, Mistry SD, Cooper CL, et al. Compartmentalization of a CD4⁺ T lymphocyte subpopulation in tuberculous pleuritis. J Immunol, 1989, 142(4): 1114-1119. pmid: 2464638
[18]	吴连革. 探讨γ-干扰素释放试验在免疫受损合并肺结核患者中的应用价值. 当代医学, 2019, 25(2):155-156. doi: 10.3969/j.issn.1009-4393.2019.02.068. doi: 10.3969/j.issn.1009-4393.2019.02.068
[19]	曹思哲. 结核性胸膜炎合并糖尿病患者临床特点及治疗观察. 吉林医学, 2012, 33(5): 923-924. doi: 10.3969/j.issn.1004-0412.2012.05.019. doi: 10.3969/j.issn.1004-0412.2012.05.019
[20]	史祥, 唐亮, 粟波. 结核性胸膜炎患者胸腔积液T淋巴细胞及白细胞介素-2的变化. 中国防痨杂志, 2014, 36(12): 1067-1070. doi: 10.3969/j.issn.1000-6621.2014.12.013. doi: 10.3969/j.issn.1000-6621.2014.12.013

结核性胸膜炎合并2型糖尿病患者外周血及胸腔积液结核感染T细胞斑点试验检测结果的对比研究

Comparative study on results of T-cell spot test for tuberculosis infection of peripheral blood and pleural effusion in tuberculous pleurisy patients complicated with type 2 diabetes mellitus

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 1

参考文献 20

相关文章 15

编辑推荐

Metrics

本文评价

友情链接

[1]	王明哲, 刘年强, 凯德丽艳·阿布都外力, 王新旗, 黄飞. 主动发现对南疆四地州肺结核疫情的影响[J]. 中国防痨杂志, 2022, 44(5): 460-466.
[2]	熊姿, 谢赐福, 宋丽新, 王孝君, 田斌, 黄竹林, 徐祖辉, 张锡兴, 白丽琼. 2011—2020年长沙市MTB/HIV双重感染流行特征分析[J]. 中国防痨杂志, 2022, 44(5): 484-488.
[3]	徐静, 罗萍, 贺晓新. 肺结核合并糖尿病与单纯肺结核患者流行特征对比分析[J]. 中国防痨杂志, 2022, 44(5): 494-499.
[4]	李玉洁, 杨雨婷, 杨国平. 糖尿病合并结核感染的固有免疫和适应性免疫反应的研究进展[J]. 中国防痨杂志, 2022, 44(5): 512-516.
[5]	贺伟, 吕平欣, 吕岩, 王东坡, 李成海, 周震, 宁锋钢, 李芳, 王岳, 孙孟言, 王依川. 非活动性结核性胸膜炎与活动性结核性胸膜炎的CT扫描影像特征分析[J]. 中国防痨杂志, 2022, 44(4): 315-321.
[6]	张黎娟, 张华, 王霞芳, 施美华, 冯彦军, 张建平, 唐佩军. 结核特异性抗原与CD4⁺ T细胞计数比值对AIDS合并肺结核的辅助诊断价值[J]. 中国防痨杂志, 2022, 44(3): 284-288.
[7]	孙桂香, 王娜, 王裕康, 仲昭亿, 李晓娜, 汪求真, 刘玉峰. 2型糖尿病合并肺结核患者感染新型冠状病毒病例报告[J]. 中国防痨杂志, 2022, 44(3): 302-304.
[8]	刘小玉, 徐风, 周逸鸣, 戴希勇, 盛健, 蒋钰辉, 刘奇斌, 申磊. 单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效观察[J]. 中国防痨杂志, 2022, 44(2): 153-158.
[9]	徐银娟, 赵国连, 崔晓利, 王佩, 谈小文, 杨珊珊, 伍浩. 新型国产改良Middlebrook液体培养试剂对结核分枝杆菌培养效果的评价[J]. 中国防痨杂志, 2022, 44(1): 60-63.
[10]	张洋婷, 卢学昭, 李晓娜, 仲昭亿, 王娜, 蔡静, 马爱国, 刘玉峰, 汪求真. 肺结核合并糖尿病患者药物性肝损伤影响因素分析[J]. 中国防痨杂志, 2022, 44(1): 64-70.
[11]	李婷, 何金戈, 夏岚, 陈闯, 肖月, 逯嘉, 王丹霞. 新型冠状病毒肺炎疫情对四川省结核病患者登记情况的影响分析[J]. 中国防痨杂志, 2021, 43(9): 929-938.
[12]	刘静, 肖慧霞, 田晓梅, 王福锐, 田旭升, 王晓平, 陈敏, 雷娟, 王晓林. GeneXpert MTB/RIF技术对宁夏地区快速发现肺结核及利福平耐药患者的应用效果评价[J]. 中国防痨杂志, 2021, 43(8): 783-789.
[13]	曹红, 邓晓岚, 钱冰, 张洁莹, 陈伟. 2014—2019年合肥市MTB/HIV双重感染防治情况分析[J]. 中国防痨杂志, 2021, 43(8): 803-807.
[14]	林岩, 邓国防. 糖尿病并发结核病治疗中多学科合作应注意的问题[J]. 中国防痨杂志, 2021, 43(7): 649-652.
[15]	黄麦玲, 孙晴, 王桂荣, 李文胜, 杜亚东, 蔡宝云, 黄海荣, 李琦, 初乃惠. Xpert MTB/RIF Ultra检测脑脊液对结核性脑膜炎的诊断价值[J]. 中国防痨杂志, 2021, 43(7): 670-676.