肺结核患者ELISPOT试验结果的影响因素分析

目的 本试验旨在分析肺结核患者酶联免疫斑点试验（ELISPOT）结果的影响因素.方法 选取西安市结核病胸部肿瘤医院住院患者共252例,其中肺结核患者130例,非结核患者122例.入院24小时内抽取患者清晨空腹抗凝静脉血,应用结核杆菌感染T细胞酶联免疫斑点诊断试剂盒进行斑点计数,并对结果进行影响因素进行分析.结果 酶联免疫斑点试验（ELISPOT）无论在男性患者与女性患者,≤16岁或＞60岁患者与16岁～60岁患者,胸部CT形成空洞患者与无空洞患者,病变范围＜2个亚段患者与≥2个亚段患者,试验结果显示均无显著性差异.结论 肺结核患者ELISPOT试验结果不受性别、年龄、空洞、病变范围等因素的影响.     

Identifying ELISPOT and skin test cut-offs for diagnosis of Mycobacterium tuberculosis infection in The Gambia.

SETTING: An urban area, The Gambia. OBJECTIVE: To identify ELISPOT and PPD skin test cut-offs, targeting sensitivity and specificity equivalence. DESIGN: Tuberculosis cases >5 years of age and their household contacts underwent ELISPOT, HIV and PPD skin tests. Cases and contacts sleeping in a different house were used to estimate sensitivity and specificity, providing two planes for estimating cut-offs. Specificity was adjusted for infection from previous exposure using a multivariate discrimination algorithm. RESULTS: The point on the line of intersection of the planes that maximised sensitivity and specificity equivalence occurred at 4 spots (95% confidence interval [CI] 3.5-5, multiplier=0 ) for CFP-10 and 5.5 spots (4.5-8, multiplier=0 for ESAT-6), yielding a sensitivity and specificity of 76% for both antigens. Combining ESAT-6 and CFP-10 using an 'or' statement yielded a maximum equivalence sensitivity and specificity of 76.5% at 6 spots for ESAT-6 and 11.5 spots for CFP-10. For the PPD skin test sensitivity and specificity, an equivalence of 78% occurred at 11 mm induration (9-13 mm). CONCLUSION: An ELISPOT cut-off for ESAT-6 or CFP-10 could be set at 4-8 spot forming units (20-40 spots per million), with little benefit from combining the results. A cut-off of 9-13 mm for the PPD skin test is reasonable when comparing with the ELISPOT.     

采用干扰素释放反应试验和PPD皮试对深圳市高校学生结核分枝杆菌潜伏感染筛查的研究

目的采用结核分枝杆菌特异性IFN-γ免疫酶联斑点法（ELISPOT）和传统的结核菌素皮试（PPD皮试）对深圳市高校学生结核分枝杆菌潜伏感染现状进行筛查,并比较两种方法的差异。方法采用自主研制的Elispot试剂盒（简称Elispot）和PPD皮试,对133例健康志愿者进行平行检测。结果A高校99例志愿者中PPD皮试有49例阳性（49.5％）,Elispot检测有20例阳性（20.2％）;B高校34例志愿者中PPD皮试有27例阳性（79.4％）,Elispot检测有2例阳性（5.9％）。对两种方法进行平行比较分析,结果有统计学差异（X^2=41.31,P〈0.005）;在PPD（卅）组中Elispot阳性率最高为28.57％;在（廾）-（-）组中分别为22.2％、12.5％及12.28％。结论结核菌特异性IFN-γ Elispot试剂盒在健康人群中检测阳性率比传统的PPD皮试要低,在诊断结核分枝杆菌潜伏感染的价值优于PPD皮试,在结核分枝杆菌潜伏感染早期诊断有较好的发展前景。     

ELISPOT检测在老年肺结核诊断中的应用价值

目的评价结核分枝杆菌特异性IFN-γ酶联免疫斑点(Elispot)检测技术对老年人肺结核的诊断价值。方法对46例老年肺结核、85例中青年肺结核、22例老年非肺结核、97例健康对照,进行Elispot检测并分析该技术诊断老年肺结核的可靠性。结果老年和中青年肺结核Elispot检测的敏感度分别为76.19%和87.5%,特异度分别为84.47%和85.29%。中青年和老年肺结核组Elispot检测阳性率显著高于其它两组(P<0.05)。结论 Elispot检测技术在诊断老年肺结核中显示出较好的敏感性和特异性,阳性率高,可用作老年肺结核的辅助诊断。     

肺结核治疗过程中类赫氏反应25例分析

目的 通过对肺结核治疗期出现类赫氏反应的机制、临床表现、诊断及治疗转归进行分析探讨.方法 分析2006～2010年收治的505例肺结核病人中出现的25例类赫氏反应.结果 类赫氏反应发生率4.95%,多数为青壮年.表现为胸水、病灶暂时性恶化、淋巴结肿大及胸壁结核等,多在抗结核治疗的初1～3个月内发生.结论 类赫氏反应多发生于强化期治疗的肺结核病人,临床诊断上需综合判定,维持原治疗方案和积极对症处理,可取得较好治疗效果.     

Rising ELISPOT count prior to the onset of symptoms of full-blown tuberculosis disease.

The relationship between the T-cell response to mycobacterial antigens and the likelihood of progression to disease has not been defined. We report a rapidly rising ELISPOT count in a 55-year-old man with evidence of Mycobacterium tuberculosis infection prior to the onset of symptoms of disease. This case illustrates the possible utility of quantitative changes in the ELISPOT count in predicting progression from M. tuberculosis infection to disease.     

Exploring the determinants of treatment success for tuberculosis cases in Europe.

SETTING: Pooled tuberculosis (TB) notifications from 13 European countries. OBJECTIVE: To analyse the determinants of TB treatment success in different countries using individual data. DESIGN: We asked 18 European countries with both outcome data and individual TB records to code outcomes for cases notified in 2000 and/or 2001. Cases completing treatment regardless of bacteriological proof of cure were considered successful. RESULTS: Ten European Union countries and Iceland, Norway and Romania participated (72% response). Among 24 660 TB cases (Romania excluded), 'success' was reported in 69% (country range 60-88%), 9% (0-11%) died, 1% (0-5%) failed, 4% defaulted or transferred (2-15%) and 12% (0-23%) were 'unknown'. On logistic regression among cases with drug susceptibility results (n = 10 303), 'success' was associated with younger age (>74 years: reference; 55-74 years: OR = 2.0, 95%CI 1.8-2.4; 35-54 years: 3.0, 95%CI 2.6-3.5; 15-34 years: 3.7, 95%CI 3.2-4.4; <15 years: 4.4, 95%CI 2.9-6.7), female sex (1.4, 95%CI 1.3-1.6), and no polyresistance (9.2, 95%CI 6.8-12.4). The Netherlands (1.6, 95%CI 1.3-2.0) and Slovakia (1.8, 95%CI 1.4-2.2) had higher success than Estonia (reference: lowest percentage success), while Austria was lower (0.64, 95%CI 0.52-0.78). CONCLUSION: Preventing drug resistance, increasing adherence and improving care in the elderly should be priorities. Inter-country variations in treatment success suggest differences in the completeness of monitoring data and in the efficacy of national control programmes.     

耐多药肺结核188例的外科治疗

目的总结耐多药肺结核（MDR—PTB）的外科治疗经验。方法上海市肺科医院胸外科自1990年1月至2005年11月共行肺结核手术906例，其中MDR—PTB188例（20．8％），手术200例次，2次手术12例；肺叶切除85例次，肺叶切除并袖式及气管、支气管成形16例次，全肺切除48例次，余肺切除术3例次，支气管胸膜瘘（BPF）瘘管修补术5例次，胸廓成形并BPF修补22例次，脓胸剥脱并BPF修补6例次，开窗引流9例次，肋床引流5例次，右总支气管节段切除1例次。术前均行有效个体化抗结核治疗2—3个月。结果术中死亡率为0．5％（1／200）。术后1年内死亡率为3．2％（6／187），其中呼吸衰竭和心肌梗死各2例，肾衰竭和大咯血各1例。并发症率为13．9％（26／187），BPF11例，占并发症的42．3％（12／26）。所有患者术前痰菌均为阳性，术后阳性2例。随访时间6．7年（3个月至15年）。术后继续术前的抗结核方案治疗3—18个月。结论对持续痰菌阳性、病灶已局限的耐多药肺结核患者，应在有效抗结核治疗的基础上手术治疗。