结核抗体蛋白芯片技术与TB-IGRA对结核病活动度及疗效的监测价值

摘要

目的 明确蛋白芯片技术、γ-干扰素释放试验(TB-IGRA)两项检测技术对结核病活动度和疗效的监测价值.方法 655例结核病患者按病变部位分为肺结核组(432例)、肺外结核组(146例)和肺结核并肺外结核组(77例),以非结核患者(248例)作为非结核对照组.应用蛋白芯片技术、TB-IGRA对各组治疗前、治疗过程中及治疗结束后6、12个月的标本进行平行检测,比较抗结核疗程中不同时相点检测阳性率的动态变化,并与集菌涂片法结果进行同步比较分析.结果 随着抗结核治疗的进行,蛋白芯片技术和TB-IGRA检出阳性率均呈下降趋势.蛋白芯片技术阳性率在初治满3个月前均低于TB-IGRA,在初治满4个月时开始下降,但下降幅度低于TB-IGRA,此后下降幅度逐渐增大,在治疗结束后6个月时阳性率仍高达18.78％,治疗结束后12个月时阳性率仍为15.27％.TB-IGRA阳性率在初治满2个月时即有明显下降,下降幅度高于蛋白芯片技术,在复治满8个月时阳性率降至8.85％,治疗结束后6个月时阳性率降至6.26％,治疗结束后12个月时阳性率降至3.82％,明显低于同时相点蛋白芯片技术.在初治满4个月之前,蛋白芯片技术与涂片结果的诊断符合率高于TB-IGRA,在初治满5个月时略下降,之后,随着疗程的进展,蛋白芯片技术与涂片结果的诊断符合率逐渐增高,但幅度均低于TB-IGRA.TB-IGRA与涂片结果的诊断符合率在初治满3个月前较低,此后随着疗程的进展,诊断符合率逐渐增高.结论 蛋白芯片技术与TB-IGRA对结核疗效均有监测价值,初治满4个月之前,蛋白芯片技术监测价值高于TB-IGRA;初治满4个月之后,蛋白芯片技术监测价值低于TB-IGRA.两种检测方法各有其优缺点,二者结合有良好的互补效应,蛋白芯片技术与TB-IGRA联合检测对结核病活动度评估和抗结核疗效监测有较高的临床价值.%Objective The aim of the study is to determine the value of protein chip technique and TB in-terferon gamma release test (TB-IGRA ) for the detection of tuberculosis activity and efficacy .Methods Ac-cording to lesion distribution ,a total of 655 patients with tuberculosis were divided into three groups :pulmo-nary tuberculosis group ,extrapulmonary tuberculosis group ,and pulmonary&extrapulmonary tuberculosis group ,with non-tuberculosis patients as the control group .Protein chip technique and TB-IGRA were adopted to compare the dynamic changes of the positive rates at different time points (prior treatment ,during therapeu-tic process ,6 and 12 months after end-of-treatment) in each group .The above results were compared and ana-lyzed with the results of bacteria-collecting smear method synchronously .Results The results showed that the positive rates of protein chip technique and TB-IGRA were decreased with the course of anti-tuberculous therapy .The positive rate of protein chip technique was lower than that of TB-IGRA during three-month ini-tial treatment period ,began to decline at the fourth month time-point ,and less than that of TB-IGRA ,then de-creased gradually .The positive rate was still respectively 18 .78％ and 15 .27％ at 6-month time-point and 12-month time-point after the end of treatment .The positive rate of TB-IGRA was evidently declined in initial treatment for 2 months ,and the decline rate was higher than that of protein chip technique .With regard to TB-IGRA ,the positive rate fell to 6 .26％ and 3 .82％ respectively at 8-month time-point and 12-month time-point in retreatment cases ,significantly lower than that of protein chip technique at the same time-points .With bac-teria-collecting smear method as the reference ,the diagnostic coincidence rate of protein chip technique was higher than that of TB-IGRA before initial treatment for 4 months ,decreased slightly at the fifth month time-point in initial treatment ,and then increased gradually with the progress of the treatment .Conclusion It is suggested that the protein chip technique and TB-IGRA have the value of monitoring the efficacy of tuberculo-sis ,and the value of protein chip technique is higher than that of TB-IGRA before initial treatment for 4 months ,and the value of protein chip technique is lower than that of TB-IGRA after the initial treatment for 4 months .Each of protein chip technique and TB-IGRA has its advantages and disadvantages ,and the combina-tion of the two assay methods has a good complementary effects .The clinical value of combined detection of protein chip technology and TB-IGRA has high clinical value in tuberculosis activity assessment and anti tu-berculosis effect monitoring .