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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

21卷

期数:

2015年04期

页码:

335-338

栏目:

临床医学

出版日期:

2015-07-15

文章信息/Info

Title:

T cell enzyme-linked immunospot tuberculous test for tuberculous pleurisy

文章编号:

1006-8147（2015）04-0335-04

作者:

庄 妍 ; 赖雁平

(天津医科大学第二医院呼吸内科,天津 300211)

Author(s):

ZHUANG Yan;  LAI Yan-ping

(Department of Respiratory, The Second Hospital , Tianjin Medical University, Tianjin 300211, China)

关键词:

结核性胸膜炎; 结核感染T细胞斑点试验; 外周血; 胸腔积液; 淋巴细胞; 渗出液

Keywords:

tuberculous pleurisy;  T cell enzyme-linked immunospot tuberculous test (T-SPOT. TB);  peripheral blood;  pleural effusion;  lymphocyte;  exudate

分类号:

R521.7

DOI:

-

文献标志码:

A

摘要:

目的： 探讨结核感染T细胞斑点试验（T-SPOT.TB）在鉴别诊断结核性胸膜炎和其他淋巴细胞为主的渗出性胸腔积液中的价值。方法： 对63例淋巴细胞为主的渗出性胸腔积液患者（32例结核性胸膜炎，31例非结核性胸膜炎）的外周血和胸腔积液单核细胞（PBMCs，PEMCs）进行T-SPOT.TB检测，评价其敏感性、特异性，并应用ROC曲线分析临界值及敏感性和特异性。结果： 结核性胸膜炎患者胸腔积液T-SPOT.TB的敏感性为93.75%，高于外周血的90.63%，但无统计学意义（χ²=0.21, P=0.641）；特异性为90.32%，明显高于外周血的67.74%（χ²=4.76, P=0.029）。胸腔积液与外周血检测形成细胞数为（532.5[260.5-1053]）SFCs/10⁶PEMC vs (166[43.5-349]) SFCs/10⁶PBMC（P<0.05）。胸腔积液的ROC曲线下面积为0.964，当取值分别为12和133 SFCs/10⁶PEMC时，敏感性分别为93.8%和81.3%，特异性为90.3%和96.8%。结论： 胸腔积液T-SPOT.TB在结核性胸膜炎诊断中具有重要的参考价值，当斑点数≥133 SFCs/10⁶PEMC特异性较高。

Abstract:

Objective： To investigate the application of mycobacterium tuberculosis T cell enzyme-linked immunospot tuberculous test (T-SPOT.TB) in the diagnosis of tuberculous pleurisy and lymphocyte-predominant pleural exudates．Methods: The peripheral blood mononuclear cells（PBMCs）and pleural effusion mononuclear cells (PEMCs) were separated from 63 patients with lymphocyte-predominant pleural exudates (32 patients of tuberculous pleurisy and 31 patients of non-tuberculous pleurisy) . Then T lymphocytes releasing interferon-γ were detected as spot forming cells with a median[interquartile range] by T-SPOT.TB assay reagent. Sensitivity and specificity were also detected. The optimum cut-off points acquired from the optimal sensitivity-specificity balance in the Receiver Operating Characteristic curves (ROC curves) were constructed. Results： In patients with tuberculous pleurisy, the sensitivity of T-SPOT.TB to pleural effusion was 93.75%, which was significantly higher than that to peripheral blood(90.63%, χ²=0.21, P=0.641). The specificity of T-SPOT.TB to pleural effusion was 90.32%, which was higher than that to peripheral blood(67.74%), but no significant difference was found (χ²=4.76, P=0.029). The frequencies of specific T cells detected by T-SPOT.TB for pleural effusion were significantly higher than for peripheral blood（532.5[260.5-1053]）SFCs/10⁶PEMC vs (166[43.5-349] SFCs/10⁶PBMC, P<0.05). Taking 12 and 133 SFCs/10⁶ PEMC as the cut-off value, the sensitivities, specificities and area under curve of T-SOPT.TB were 93.8% and 81.3%, 90.3% and 96.8%, and 0.964, respectively. Conclusion： The T-SPOT.TB assay of pleural effusion could have great importance for the diagnosis of tuberculous pleurisy, and it has higher specificity when the frequencies of specific T cells≥133SFCs/10⁶PEMC.

参考文献/References:

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相似文献/References:

[1]李锐成,杨文青,沈建军,等.结核感染T细胞斑点试验诊断结核性胸膜炎的评价[J].天津医科大学学报,2016,22(06):531.

备注/Memo

备注/Memo:

作者简介 庄妍（1983-），女，医师，硕士在读，研究方向：呼吸内科；通信作者：赖雁平，E-mail: laintianyun@163.com。

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更新日期/Last Update: 2015-07-17