T－SPOT.TB对免疫低下合并结核性胸膜炎患者的诊断价值

摘要

目的：探讨结核杆菌T细胞斑点实验（T－SPOT．TB）对免疫低下合并结核性胸膜炎患者的诊断价值。方法：比较T－SPOT．TB、腺苷脱氨酶（ADA）、TB－DNA 法及结核抗体检测54例免疫低下合并结核性胸膜炎患者的诊断灵敏度。其中有22例患者在抗结核治疗第2个月末复查 T－SPOT．TB，比较治疗前后 T－SPOT．TB斑点形成细胞数的变化。结果：在对54例确诊为免疫低下合并结核性胸膜炎患者中，T－SPOT．TB诊断灵敏度（79．63％）显著高于ADA（64．81％）、TB－DNA（48．15％）及结核抗体（55．56％）（P ＜0．05）。22例患者在抗结核治疗2个月后复查 T－SPOT．TB 值，T－SPOT．TB 阳性率为90．91％，较治疗前无明显变化（P ＞0．05）。测试孔A和B斑点细胞数（SFC）较治疗前下降（（t ＝2．728和2．400，均P ＜0．05）。结论：T－SPOT．TB诊断免疫低下合并结核性胸膜炎患者具有良好的灵敏度，且对其诊断具有重要临床价值。%Objective To explore the clinical value of tuberculous infection of T cells spot test (T-SPOT. TB)for diagnosing tuberculous pleurisy in immunocompromised patients. Methods The sensitivities of T-SPOT. TB,ADA, TB-DNA and tuberculosis antibodies to tuberculous pleurisy in 54 immunocompromised patients were compared.Among these patients,22 were retested by T-SPOT. TB after 2 months anti-tuberculosis treatment. Spot forming cells(SFCs) were compared before and after treatment. Results The diagnostic sensitivity of T-SPOT.TB (79.63%)was significantly higher than those of ADA (64.81%),TB-DNA (48.15%)and tuberculosis antibodies (55.56%) (P<0.05).22 patients were retested by the T-SPOT.TB after anti-TB treatment (2 months), the results showed that the positive rate of T-SPOT.TB was 90.91%,not significantly than previous tests (P<0.05).Both ESAT-6 and CFP-10 specific SFCs decreased significantly compared with those before anti-TB treatment (t=2.728 and 2.400,P<0.05 respectively). Conclusions T-SPOT.TB assay has satisfactory sensitivity and could be used in diagnosis of tuberculous pleurisy in immunocompromised patients.