T细胞斑点试验在肺结核诊断和疗效评价中的意义

目的探讨基于γ-干扰素释放的T细胞斑点试验（T—SPOT．TB）对诊断肺结核及评价抗结核疗效的意义。方法采用T—SPOT．TB检测55例活动性肺结核患者、14例肺部病变非肺结核患者和12名健康体检者外周血特异性T细胞释放IFNγ的斑点形成细胞数（SFC），并对20例痰菌及T—SPOT．TB均阳性的活动性肺结核患者在治疗前、治疗第2个月末和第6个月末分别行T—SPOT．TB检测。多组间的比较采用多个独立样本Kruskal—WallisH检验，组间两两比较采用Mann—WhitneyU检验，治疗前后SFC数值差异比较采用Wilcoxon符号秩检验。结果肺结核组T—SPOT．TB阳性率（85．5％，47／55）显著高于肺部疾病组（2／14）和健康对照组（1／12）（X^2=40．926，P〈0．05）。肺结核组T—SPOT．TB的早期分泌抗原（ESAT-6）孔（A孔）和培养滤过蛋白（CFP-10）孔（B孔）SFC分别为70．00（27．00～125．00）和80．00（17．00～180．00），显著高于肺部疾病组和键康对照组，差异具有统计学意义（，=35．376和30．485，P值均〈0．05）。T—SPOT．TB诊断菌阳和菌阴肺结核的敏感度、特异度、阳性预测值和阴性预测值分别为88．6％和80．0％，88．5％和88．5％，91．2％和84．2％，85．0％和85．2％，差异无统计学意义（P〉0．05）。痰菌及T—SPOT．TB均阳性的20例活动性肺结核患者治疗前测试孔A和孔B的SFC分别为75．50（41．25～116．25）和56．25（105．00～225．00），治疗2个月的测试孔A和孔B的SFC分别为41．0（18．00～68．75）和72．50（42．25～158．75），较治疗前下降（z=-3．213和-3．622，P值均〈0．05）；治疗6个月末，测试孔A和B的SFC分别为25．00（5．75—52．25）和55．00（6．25～122．50），较治疗前明显下降（Z=-3．921和-3．923，P〈0．05），较治疗2个月时下降差异也有统计学意义（Z=-3．926和-3．884，P〈0．05）。结论T—SPOT．TB对诊断结核分枝杆菌感染及监测抗结核治疗疗效上有重要意义，且对痰菌阴性肺结核具有重要的诊断价值。

T-SPOT. TB assay in diagnosis and efficacy assessment of pulmonary tuberculosis

Objective To evaluate the application of interferon-3, release assay T-SPOT. TB in diagnosis and efficacy assessment of pulmonary tuberculosis. Methods T-SPOT. TB assay was used to determine spot-forming cells （SFCs） formed by T-cells when stimulated by Mycobacterium tuberculosis- specific antigens in 55 patients with active tuberculosis, 14 patients with non-tuberculosis lung diseases and 12 healthy controls. Meanwhile 20 sputum culture-positive and qualitative assay-positive pulmonary tuberculosis patients were tested with T-SPOT. TB before and at 2-month and 6-month after treatment. Kruskal-Wallis H and Mann-Whitney U test were used in group comparison. Wilcoxon test was used in comparison between pre- and post-treatment. Results The positive rate of T-SPOT. TB was significantly higher in patients with tuberculosis （ 85. 5% , 47/55 ） than that in patients with non-tuberculosis lung diseases （2/14） and the healthy controls （1/12） （X2 =40. 926, P 〈 0.05）. The SFCs of hole A in response to ESAT-6 and hole B in response to CFP-10 in puhnonary tuberculosis group were 70.00 （27.00- 125.00） and 80.00 （ 17.00 - 180.00） , respectively, which were all significantly higher than those in non- tuberculosis lung diseases group and the healthy controls （X2 = 35. 376 and 30. 485, P 〈 0.05 ）. The sensitivity, specificity, positive predictive value and negative predictive value of T-SPOT. TB in diagnosis of smear-positive tuberculosis were 88.6% , 88.5% , 91.2% and 85% , while in diagnosis of sputum smear- negative tuberculosis, the sensitivity was 80%, specificity was 88. 5%, positive predictive value was 84.2% and negative predictive value was 85.2% （P 〉 0.05 ）. SFCs of hole A and hole B in 20 patients with sputum culture-positive and qualitative assay-positive pulmonary tuberculosis were 75.50 （41.25 - 116.25 ） and 56.25 （ 105.00 - 225.00） before the treatment. After 2-month antituberculosis treatment, the SFCsofhole A and hole B were 41.0 （18.0 -68.75） and 72. 50 （42. 25 - 158. 75）, which were significantly lower than those before treatment （ Z = - 3. 213 and - 3. 622, P 〈 0.05 ）. After 6-month auti/uberculosis treatment, the SFCs of hole A and hole B were 25.00 （5.75 - 52.25 ） and 55.00 （6.25 - 122.50） , which were significantly lower than those before and 2-month after antituberculosis treatment （ vs. bch~re treatment： Z = - 3. 921 and - 3. 923, P 〈 0.05; vs. 2-month antituberculosis treatment： Z = - 3. 926 and - 3. 884, P 〈0. 05）. Conclusions T-SPOT. TB assay possess satisfactory sensitivity and specificity in diagnosis of tuberculosis infection, especially for sputum-negative pulmonary tuberculosis. It is also of value in monitoring antituberculosis treatment.