酶联免疫斑点试验快速检测结核分枝杆菌感染的应用评价

目的评价γ干扰素释放实验(IGRA)诊断活动性结核病的价值。方法选取130例胸片异常的出入境人员,根据胸片是否存在活动性病变将研究对象分为试验组(60例)和对照组(70例),采取IGRA检测试剂盒T SPOT.TB,测定结核杆菌特异抗原刺激反应的效应T淋巴细胞数量,结合实验室痰菌涂片和培养结果评价该技术对活动性肺结核的筛查价值。结果T-SPOT.TB在筛查临床诊断的活动性肺结核患者中的敏感性与结核菌素皮肤试验(TST)接近,分别为73.3%比78.3%特异性显著优于TST试验(结核菌素皮肤试验),为60%和27.3%;在痰菌检查阳性的活动性肺结核确诊患者和痰菌检查阴性的对照组受试者中,T-SPOT.TB诊断活动性肺结核患者的敏感性和特异性进一步提高,与TST试验相比,敏感性为93.1%比75.9%,特异性为62.7%比35.8%。结论T-SPOT.TB检测活动性肺结核的敏感性高,优于传统的TST方法,提示该技术可用于在临床疑似结核病患者中快速筛查活动性肺结核。

Analysis of a new rapid method for diagnosis on Tuberculosis infection

Objective To evaluate the performance of y Interferon releasing assay （IGRA） in the screening of active pulmonary tuberculosis （TB）. Methods A total of 130 TB suspected cases with chest X-ray abnormality from the population who accepted physical examination at Shanghai port were divided into two groups： clinically diagnosed active TB group and non-active TB control group. One international launched commercial IGRA kit （T-SPOT.TB assay, Oxford lmmunotec Ltd from England） was used to detect the blood samples and the results were compared with the results of routine diagnosis methods including TB skin test （TST） and sputum smear and culture. Results In clinical suspected active pulmonary TB cases, the sensitivity of T-SPOT.TB was close to TST（73.3% vs. 78.3%）,the specificity of T-SPOT.TB were higher than TST （60% vs.27.3%）. While combining the results of sputum bacteriological examination, the sensitivity, specificity of T-SPOT.TB increased to 93.1% and 62.7%, much higher than those of TST （75.9% and 35.8%）. Conclusion T-SPOT.TB is more sensitive and specific than TST in the diagnosis of active pulmonary TB and identification of suspected cases with active tuberculosis.