结核T细胞酶联免疫斑点试验诊断结核感染的临床应用

 目的 探讨结核T细胞酶联免疫斑点试验(T-SPOT.TB)诊断结核感染的临床应用价值。方法 选择结核分枝杆菌感染者103例及非结核病对照者30例，用酶联免疫斑点试验检测外周血单个核细胞经结核特异性蛋白6KD早期分泌靶向抗原，以及培养滤液蛋白10刺激产生γ-干扰素的T淋巴细胞数，并与血清抗结核抗体、结核菌素皮肤试验结果比较。结果 T-SPOT.TB诊断结核感染的敏感性和特异性为95.15% 、93.33%;阳性预则值和阴性预测值为98.00%、84.85% ;阳性似然比和阴性似然比为14.27%、0.05%，均优于血清抗结核抗体、结核菌素皮肤试验(P<0.01)，但方法间一致性较弱(Kappa＜0.40，P<0.001)，差异有统计学意义。结论 T-SPOT.TB检测在结核分枝杆菌(MTB)感染的筛查，快速早期辅助结核病诊断和排除感染方面意义重大。

Clinical application of T cell enzyme-linked immunospot assay in tuberculosis patients

Objective To investigate the diagnostic value of T cell enzyme-linked immunospot (ELISPOT) assay in tuberculosis patients. Methods 103 patients with Mycobacterium tuberculosis (MTB) infection and 30 controls with non-MTB infection were recruited to detect early secreting antigen target-6(ESAT-6) and culture filtrate protein-10(CFP-10) specific T cells in blood samples by ELISPOT assay, then compare it with serum tuberculosis antibody(TB-Ab) and PPD skin test. Results The sensitivity, specificity, positive prospective value, negative prospective value, positive likelihood ratio and negative likelihood ratio of T cell ELISPOT assay were 95.15%, 93.33%, 98.00%, 84.85 %, 14.27% , and 0.05%, respectively. All these indexes were significantly higher than those of TB-Ab and PPD skin test(P<0.01), meanwhile T cell ELISPOT assay had low agreement with means of TB-Ab and PPD skin test(Kappa＜0.40, P<0.001). Conclusions T cell ELISPOT assay has a higher sensitivity and specificity than conventional test in the diagnosis of tuberculosis; therefore,it has great value and applicability as a screening test.