T-SPOT.TB和SAT-TB联合检测诊断涂阴肺结核
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摘要
目的应用结核感染T细胞斑点试验(T-SPOT.TB)和支气管肺泡灌洗液(BALF)结核分枝杆菌RNA恒温扩增实时检测技术(SAT-TB)联合应用检测诊断痰涂阴性肺结核。方法选择2014年11月—2016年5月杭州市红十字会医院收治的疑诊肺结核、痰涂阴性患者进行全血T-SPOT.TB检测,收集BALF样品进行萋尼-抗酸杆菌染色(AFB)、结核分枝杆菌快速培养(MGIT960)和SAT-TB等检测。以临床诊断为金标准,采用ROC曲线分析比较不同检测效果。结果共纳入252例患者,其中肺结核患者197例,非肺结核患者55例。BALF-AFB、MIGT960、SAT-TB、T-SPOT.TB、 T-SPOT.TB和SAT-TB,以及T-SPOT.TB或SAT-TB检测敏感度分别为16.24%、 32.49%、 69.54%、95.43%、65.48%和99.49%;特异度分别为98.18%、90.91%、87.27%、56.36%、98.18%和43.64%;AUC值分别为0.572、 0.617、 0.784、 0.759、 0.818和0.725。其中T-SPOT.TB和SAT-TB阳性预测值为99.23%, T-SPOT.TB或SAT-TB阴性预测值为96.00%。诊断价值从高到低依次为T-SPOT.TB和SAT-TB、T-SPOT.TB或SAT-TB、MIGT960及BALF-AFB (均P<0.05)。结论 T-SPOT.TB联合SAT-TB检测可应用于痰涂阴性肺结核患者的诊断。
引文
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[12]LALVANI A,PAREEK M.Interferon gamma release assays:principles and practice[J].Enferm Infect Microbiol Clin,2010,28(4):245-252.
[13]LIU Y,OU Q,ZHENG J,et al.A combination of the QuantiF-ERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion[J].Emerging Microbes&Infections,2016,5(8):e83.
[14]YAN L,XIAO H,HAN M,et al.Diagnostic value of T-SPOT.TB interferon-γrelease assays for active tuberculosis[J].Experimental and Therapeutic Medicine,2015,10(1):345-351.
[2]乐军,梁莉,李苏辉,等.酶联免疫斑点试验快速诊断结核分枝杆菌感染的临床应用价值[J].中华检验医学杂志,2006,29(11):1005-1008.
[3]KOBASHI Y,MOURI K,YAGI S,et a1.Transitional chanses in T cell responses to Mycobacterium tuberculosis specific antigens during treatment[J].J Infect,2009,58(3):197-204.
[4]EWER K,DEEKS J,ALVAREZ L,et al.Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak[J].Lancet,2003,361(9365):1168-1173.
[5]DAI Y,FENG Y,XU R,et al.Evaluation of interferon-gamma release assays for the diagnosis of tuberculosis:an updated meta-analysis[J].Eur J Clin Microbiol Infect Dis,2013,32(7):967-967.
[6]FAN L,CHEN Z,HAO X H,et al.Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis:a systematic review and meta-analysis[J].FEMS Immunol Med Microbiol,2012,65(3):456-466.
[7]崔振玲,沙巍,黄晓辰,等.RNA恒温扩增技术快速检测痰标本中结核分枝杆菌的研究[J].中华结核和呼吸杂志,2011,34(12):894-897.
[8]FAN L,ZHANG Q,CHENG L,et al.Clinical diagnostic performance of the simultaneous amplification and testing methods for detection of the Mycobacterium tuberculosis complex for smear-negative or sputum-scarce pulmonary tuberculosis in China[J].Chin Med J(Engl),2014,127(10):1863-1867.
[9]张贺秋,赵雁林.现代结核病诊断技术[M].北京:人民卫生出版社,2013:282-285.
[10]张培元.肺结核诊断和治疗指南[J].中华结核和呼吸杂志,2001,24(2):70-74.
[11]王静,刘立宾,岳永宁,等.SAT-TB检测支气管肺泡灌洗液诊断肺结核的价值研究[J].预防医学,2018,30(4):429-431.
[12]LALVANI A,PAREEK M.Interferon gamma release assays:principles and practice[J].Enferm Infect Microbiol Clin,2010,28(4):245-252.
[13]LIU Y,OU Q,ZHENG J,et al.A combination of the QuantiF-ERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion[J].Emerging Microbes&Infections,2016,5(8):e83.
[14]YAN L,XIAO H,HAN M,et al.Diagnostic value of T-SPOT.TB interferon-γrelease assays for active tuberculosis[J].Experimental and Therapeutic Medicine,2015,10(1):345-351.