结核感染T细胞检测在肺外结核诊断应用价值

目的探讨结核感染T细胞检测在肺外结核诊断应用价值。方法选取本院2012年1月-2013年12月依据结核病原学、组织病理学、诊断性治疗有效及影像学支持临床诊断肺外结核病例80例,25例非结核肺部疾病以及8例健康对照。选用英国Oxford Immunotec Ltd.生产的结核感染T细胞检测试剂盒,按照使用说明操作六部法进行检测。利用蛋白芯片技术检测结核杆菌三种抗原的IgG抗体、痰抗酸染色涂片检查及痰结核分枝杆菌培养(采用改良罗氏法)。结果T-SPOT.TB在肺外结核病阳性率为81.3%、敏感度为84.2%、特异度97.1%、诊断效率87.6%。肺外结核组TSPOT.TB检测阳性率明显高于非结核疾病和健康对照组,差异有统计学意义(P0.01)。肺外结核疾病各组间敏感度、特异度、诊断效率比较差异无统计学意义(P0.05)。肺外结核疾病利用T-SPOT.TB和结核杆菌蛋白芯片检测方法配对比较,前者明显高于后者,差异有统计学意义(P0.01)。结论肺外结核多脏器及临床表现差异性及复杂性,需要临床经验、有效的辅助检查诊断,T-SPOT.TB检测是结核病诊断金标准之外的非常有效辅助诊断方法,可节约诊断时间及不必要检查,可更好利用医疗资源同时减轻患者负担,更好防治结核病。

Application value of T.SPOT.TB test in the diagnosis of extrapulmonary tuberculosis

Objective To explore the diagnostic value of T-SPOT. TB test in extrapulmonary tuberculosis. Methods From January 2012 to December 2013,we recruited 80 extrapulmonary TB patients and 25 non-tuberculous lung disease patients who were clinically diagnosed by Infectious Diseases Hospital Affiliated to Soochow University based on tuberculosis etiology,histopathology,effective therapy through correct diagnosis and image diagnostics. And 8 healthy people were selected as controls. The T-SPOT. TB test kits produced by Oxford Immunotec Ltd. were employed to detect the samples according to the instructions. The protein chip technology was used to detect the IgG antibodies to three antigens of Mycobacterium tuberculosis. Direct smear of sputum was conducted with acid-fast staining to detect Mycobacterium tuberculosis. And Mycobacterium tuberculosis from sputum samples was cultured using modified L-G method. Results The positive rate,sensitivity,specificity and diagnostic efficiency of the T-SPOT. TB in detecting extrapulmonary tuberculosis were 81. 3%,84. 2%,97. 1% and 87. 6%,respectively. The T-SPOT. TB positive rate was significantly higher in extrapulmonary tuberculosis group than in non-tuberculous lung disease group and control group,and the differences were statistically significant（ P〈0. 01）. No statistically significant difference was found in the sensitivity,specificity and diagnostic efficiency among extrapulmonary disease groups（ P〉0. 05）. Paired comparing the detection methods of T-SPOT. TB and Mycobacterium tuberculosis protein chip,the former was significantly higher than the latter,with statistically significant differences（ P〈0. 01）. Conclusions Due to the diversity and complexity of clinical manifestations of extrapulmonary tuberculosis diseases,the diagnoses need clinical experiences and effective auxiliary examinations. The T-SPOT.TB test is a very effective auxiliary means for the diagnosis of TB besides the gold standard. This detection method saves the diagnostic time and unnecessary