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

doi:10.3969/j.issn.1000-6621.2018.08.013

Abstract

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

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. The diagnostic value of T cell enzyme-linked immunospot tuberculosis assay in diabetes complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2018, 40(8): 846-853. doi: 10.3969/j.issn.1000-6621.2018.08.013

Figures/Tables 3

References 45

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人口学特征	Ⅰ组(141例)	Ⅱ组(66例)	Ⅲ组(95例)	χ²值	P值
性别				3.52	0.172
男[例数(构成比,%)]	118(83.7)	48(72.7)	74(77.9)
女[例数(构成比,%)]	23(16.3)	18(27.3)	21(22.1)
年龄(岁)				24.39	<0.01
中位数	52	54	61
四分位数(P₂₅,P₇₅)	44,61	45,66	55,70
BMI				11.07	0.004
中位数	21.97	22.24	23.12
四分位数(P₂₅,P₇₅)	20.07,23.69	20.02,24.52	20.94,25.69
低白蛋白[例数(比率,%)]	42(29.8)	12(18.2)	26(27.4)	3.16	0.206
有TB接触史[例数(比率,%)]	8(5.7)	4(6.1)	5(5.3)	0.15	0.999
接种过卡介苗[例数(比率,%)]	85(60.3)	24(36.4)	57(60.0)	11.70	0.003
抽烟[例数(比率,%)]	68(48.2)	28(42.4)	37(38.9)	2.07	0.355
饮酒[例数(比率,%)]	55(39.0)	20(30.3)	25(26.3)	4.43	0.109

临床特征	Ⅰ组(141例)	Ⅱ组(66例)	χ²值	P值
主诉
咳嗽	131(92.9)	55(83.3)	4.52	0.033
咳痰	123(87.2)	50(75.8)	4.31	0.038
发热	60(42.6)	23(34.8)	1.11	0.292
咳血	26(18.4)	16(24.2)	0.94	0.333
盗汗	42(29.8)	11(16.7)	4.06	0.044
体质量减轻	44(31.2)	11(16.7)	4.87	0.027
抗酸杆菌阳性	129(91.5)	14(21.2)	103.96	<0.01
结核病变范围			12.58	<0.01
≤3个肺野	61(43.3)	46(69.7)
≥4个肺野	80(56.7)	20(30.3)
空洞及其范围			10.71	0.003
无空洞	58(41.1)	43(65.2)
≤3个肺野	79(56.0)	23(34.8)
≥4个肺野	4(2.9)	0(0.0)
结核病病程			1.06	0.302
<1个月	18(12.8)	12(18.2)
≥1个月	123(87.2)	54(81.8)
患者类型			1.46	0.226
初治	115(81.6)	49(74.2)
复治	26(18.4)	17(25.8)

因素	患者例数 (207例)	T-SPOT.TB检测阳性例数(188例)	阳性率 (%)	χ²值	P值
性别				1.10	0.294
男	166	153	92.2
女	41	35	85.4
年龄(岁)				0.32	0.571
>65	39	34	87.2
≤65	168	154	91.7
BMI				0.00	0.999
<18.5	27	25	92.6
≥18.5	180	163	90.6
白蛋白				0.06	0.802
正常	153	138	90.2
降低	54	50	92.6
痰培养				2.31	0.129
阳性	141	131	92.9
阴性	66	57	86.4
痰涂片				2.65	0.104
阳性	143	133	93.0
阴性	64	55	85.9
病变范围				0.32	0.570
≤3个肺野	107	96	89.7
≥4个肺野	100	92	92.0
空洞				0.37	0.541
有	106	95	89.6
无	101	93	92.1
空洞范围				-^a	0.302
≤3个肺野	203	185	91.1
≥4个肺野	4	3	75.0
结核病病程(月)				0.03	0.862
<1	30	28	93.3
≥1	177	160	90.4
患者类型				0.00	0.999
初治	164	149	90.9
复治	43	39	90.7
结核病接触史				0.00	0.999
有	12	11	91.7
无	195	177	90.8
疫苗接种				0.24	0.628
有	109	100	91.7
无	98	88	89.8
抽烟				0.01	0.928
有	96	87	90.6
无	111	101	91.0
饮酒				0.00	0.954
有	75	68	90.7
无	132	120	90.9