结核分枝杆菌TB—SA抗体检测在结核病诊断中价值的研究

目的研究结核分枝杆菌TB—SA抗体检测在结核病诊断中的价值。方法对1232例结核病、非结核病的其他呼吸系统疾患患者及健康志愿者同日寸进行抗酸杆菌涂片、培养、PPD皮试及结核分枝杆菌TB—SA抗体检测。结果①结核分枝杆菌TB—SA抗体检测菌阳肺结核的敏感性为75．1％；菌阴肺结核的敏感性为68．9％；肺外结核病的敏感性为71．2％；诊断结核病的总体敏感性为72．0％，特异性为82．1％。②TB—SA血清抗体检测OD405值并不与PPD值成线性关系，结核分枝杆菌TB—SA抗体检测对结核病人的诊断不受患者卡介苗反应的影响。结论结核分枝杆菌TB—SA抗体检测诊断结核病有较好的敏感性和特异性，是结核病诊断和鉴别诊断的可靠手段。     

蛋白芯片检测诊断结核病分析

目的探讨结核蛋白芯片检测对诊断结核病的价值。方法使用蛋白芯片系统检测患者血清结核抗体,蛋白芯片技术检测结核分枝杆菌(MTB)中5种成分,即ESAT-6、CFP10、LAM、38KD和16KD。结果共检测4439例,其中结核病458例,非结核病3931例,HIV/AIDS组(其中结核病12例,非结核病38例)。458例结核病患者中315例结核抗体阳性,阳性率为68.78%;3931例非结核病例734例阳性,阳性率为18.67%;HIV/AIDS组(结核病患者阳性率66.67%,非结核病例阳性率为28.95%)。结论结核蛋白芯片是诊断结核病的较有效方法,具有特异性好、快速方便等优点,对结核病快速辅助诊断起积极作用。     

血清结核抗体在结核病诊断中的价值

血清结核抗体的检测作为结核病的辅助诊断之一,近几年广泛应用于临床。我院于1997年10月至1998年9月期间,使用结核抗体快速诊断药盒对活动性结核病人和非结核病人的血清进行检测,观察结核抗体测定对结核病的诊断价值。 1 资料和方法 1.1 临床资料:本文全部病例根据临床表现、影像学检查、痰检、病理检查、及治疗转归而确诊。(1)活动性     

TB-SA抗体检测对结核病临床诊断价值的研究

目的对TB-SA(Tuberculosis-Specific Antigen)抗体检测用于结核病诊断的价值进行评估。方法2004年5—11月在山东省胸科医院住院的活动性结核病患者230例(菌阳肺结核60例,菌阴肺结核131例,肺外结核39例),非结核呼吸系统疾患者96例,无结核疾患的在校大学生健康志愿者41人,入选病例留取的痰、胸腔积液、腹腔积液、脑脊液标本同时进行抗酸杆菌浓缩集菌,结核杆菌培养,血清样本进行TB-SA抗体检测。结果活动性结核病人血清学检测TB-SA抗体总的敏感性为67.8%。活动性肺结核敏感性为67.6%,肺外结核敏感性为59.0%(P>0.05);诊断结核病总的特异性为76.6%,在非结核呼吸系统疾患中为72.9%,在健康人群中为85.4%。结论TB-SA抗体检测是一种快速、简单、有较好敏感性和特异性的结核病辅助诊断手段,对菌阴肺结核及不易取得细菌学检查标本的肺外结核病、儿童结核病有较高的参考价值。     

结核分枝杆菌特异性蛋白抗体检测在肺外结核病诊断中的价值

目的研究结核分枝杆菌特异性蛋白(TB-SA)抗体检测在肺外结核病诊断中的价值。方法对71例肺外结核病患者和40例健康志愿者进行血清结核分枝杆菌特异蛋白抗体检测,并对各种肺外结核病引流物标本进行AFB涂片和培养检查。结果结核分枝杆菌TB-SA抗体检测诊断菌阳肺外结核病敏感度为87.5%(7/8),诊断菌阴肺外结核的敏感度为63.5%(40/63),诊断肺外结核总体敏感度为66.2%(47/71),特异度为97.5%(39/40)。结论结核分枝杆菌TB-SA抗体检测诊断肺外结核病有较好的敏感性和特异性,是辅助诊断和鉴别诊断肺外结核病较为理想的免疫学方法之一。     

结核抗体与痰检结果的比较分析

目的 探讨结核抗体在结核病的诊断、鉴别诊断以及疗效观察中的价值。方法 通过对324例患者血清结核抗体和痰检的结果进行对比分析。结果 结核抗体检测的阳性率为45．99％,痰检的阳性率24．69％。结论 血清结核抗体的检测是近年发展起来的一种比较理想的检测方法。     

TB-SA抗体检测对结核病临床诊断价值的研究

目的　对TB-SA(Tuberculosis-Specific Antigen)抗体检测用于结核病诊断的价值进行评估。方法 2004年5—11月在山东省胸科医院住院的活动性结核病患者230例(菌阳肺结核60例,菌阴肺结核131例,肺外结核39例),非结核呼吸系统疾患者96例,无结核疾患的在校大学生健康志愿者41人,入选病例留取的痰、胸腔积液、腹腔积液、脑脊液标本同时进行抗酸杆菌浓缩集菌,结核杆菌培养,血清样本进行TB-SA抗体检测。结果 活动性结核病人血清学检测TB-SA抗体总的敏感性为67.8%。活动性肺结核敏感性为67.6%,肺外结核敏感性为59.0%(P>0.05);诊断结核病总的特异性为76.6%,在非结核呼吸系统疾患中为72.9%,在健康人群中为85.4%。结论 TB-SA抗体检测是一种快速、简单、有较好敏感性和特异性的结核病辅助诊断手段,对菌阴肺结核及不易取得细菌学检查标本的肺外结核病、儿童结核病有较高的参考价值。     

结核抗体测定的临床诊断应用价值

目的抗结核抗体检测方法与其他检查方法比较,探讨抗体检测对结核病诊断的价值.方法采用酶联免疫吸附试验(ELISA)法对380份血清(包括肺内、外)其中有结核组、非结核组进行结核抗体测定.结果两组之间有显著差异性(P<0.005),灵敏度为82.3%,特异度为96.2%.结论结核抗体测定有较高特异性和灵敏度,对结核病的诊断和与非结核病的鉴别诊断具有重要参考价值.通过结核抗体的检测,可为临床诊断和规律治疗提供更有价值的依据.     

结核分枝杆菌抗体检测在结核病诊断中的价值

目的：探讨结核分枝杆菌抗体检测在结核病诊断中的价值。方法：对所有观察对象进行结核分枝杆菌抗体检测，对肺内、外结核及非结核肺部疾病患者，进行痰结核分枝杆菌涂片、培养。结果：结核分枝杆菌抗体检测结核病的总敏感度为72．3％，特异度为84．2％。结论：结核分枝杆菌抗体检测诊断结核病有较好的敏感度和特异度，是辅助和鉴别诊断结核病的有效手段。     

Rv1656重组蛋白在结核病辅助诊断中的应用价值研究

目的研究结核分枝杆菌Rv1656重组蛋白在结核病辅助诊断中的应用价值。方法以痰涂片、痰培养及3个商品化的结核杆菌抗体试剂盒为对照,应用化学发光酶免疫分析法检测42例结核病患者和54例非结核肺部疾病患者尿液中抗Rv1656抗体水平;绘制抗Rv1656抗体检测工作特征曲线(ROC曲线),确定其诊断结核病的临界值,并评价其诊断效能。结果结核病组患者尿液抗Rv1656抗体为(39517.2±11802.7pg/ml),非结核呼吸病组为(11416.3±1145.4pg/ml),差异有统计学意义(t=3.002,P<0.01);痰菌阴性结核病患者尿液中抗Rv1656抗体为(47011.4±1529.9pg/ml),痰菌阳性结核患者为(15535.7±1629.7pg/ml),差异有统计学意义(t=2.035,P<0.05)。尿Rv1656抗体诊断结核的灵敏度为42.8%,上海奥普血清结核抗体试剂盒为71.4%,差异有统计学意义(χ2=63.87,P<0.01)。尿Rv1656抗体诊断结核的特异性为83.3%,上海奥普血清结核抗体试剂盒为38.9%,差异有统计学意义(χ2=76.15,P<0.01)。结论结核分枝杆菌Rv1656重组蛋白具有抗原特异性可作为尿液结核抗体检测的组合抗原之一。     

抗结核抗体检测方法及临床意义

目的 探讨抗结核抗体检测技术在临床诊断中的应用价值.方法 对1823例确诊肺结核患者、580例非结核病的其他呼吸系统疾病患者及500名健康体检者进行抗酸染色法、酶联免疫吸附试验(ELISA)法、金标法及蛋白芯片法检测,并进行相关统计分析.结果 ELISA法、金标法及蛋白芯片法对肺结核患者的检出敏感性分别为59.1%、62.7%和71.2%,均显著高于抗酸染色(18.4%).蛋白芯片法对抗酸染色阴性肺结核患者的抗结核抗体检出率为67.9%.结论 3种结核抗体检测技术均可用于肺结核的快速辅助诊断.相对于ELISA法及金标法而言,蛋白芯片法敏感性和特异性更高,对痰菌阴性肺结核患者的辅助诊断更具积极意义.     

荧光探针杂交技术检测临床标本内结核分支杆菌的价值

目的　评价聚合酶链反应(PCR)荧光探针杂交技术(TaqMan技术)检测临床标本中结核分支杆菌的应用价值。方法 应用细菌学方法(涂片镜检和培养)及TaqMan法检测133份结核病患者痰标本,53份非结核呼吸系疾病患者痰标本。结果 细菌学方法检测结核病患者临床标本中结核分支杆菌阳性率为36.1%,TaqMan法阳性率为61.7%,高于细菌学检测法,经统计学处理,两者有显著性差异(P<0.05),用TaqMan法检测临床标本特异性为96.2%。结论 TaqMan技术将PCR扩增、荧光探针杂交及检测一体化,在单一管内完成,具有简便、快速、防污染、敏感性及特异性较高等优点,是结核病辅助诊断的有效方法之一。     

Evaluation of the FASTPlaqueTB assay for direct detection of Mycobacterium tuberculosis in sputum specimens.

SETTING: Sputum samples were collected from suspected tuberculosis patients attending out-patient clinics at the Ojha Institute of Chest Diseases, Karachi, Pakistan. OBJECTIVE: To evaluate the performance of the FASTPlaqueTB assay for rapid diagnosis of pulmonary tuberculosis. DESIGN: A comparative study of 584 sputum samples using acid-fast smear microscopy, Lowenstein-Jensen culture and FASTPlaqueTB. RESULTS: A total of 514 samples yielded complete results. Seventy specimens were lost to analysis due to the overgrowth of contaminants. The addition of antimicrobials inhibited growth of gram-positive contaminants, and reduced the overall contamination rate from 18.2% to 7.2%. Mycobacterium tuberculosis was isolated from 175 smear-positive and 70 smear-negative specimens. FASTPlaqueTB detected M. tuberculosis in 81.6% of specimens, with a specificity of 97.7%. The sensitivity and specificity of the assay for smear-positive specimens were respectively 87.4% and 88.2%. For smear-negative specimens, the sensitivity of the assay was 67.1% and the specificity was 98.4%. The combined sensitivity of smear and FASTPlaqueTB for M. tuberculosis was 90%. Test results were available in 48 hours. CONCLUSION: FASTPlaqueTB is a sensitive and specific test for rapid diagnosis of pulmonary tuberculosis in high prevalence areas. The test is sensitive enough to confirm a large number of clinically suspected smear-negative cases and improve case finding.     

45/47 kilodalton (APA) antigen capture and antibody detection assays for the diagnosis of tuberculosis.

SETTING: APA complex (45/47 kDa) is an antigen specifically excreted by Mycobacterium tuberculosis and could therefore be a good candidate for diagnosis. OBJECTIVES: To develop three APA immunocapture ELISA assays using monoclonal antibodies (Mabs) and one IgG anti-APA ELISA test, and to determine their usefulness for the diagnosis of tuberculosis in Madagascar. DESIGN: For the Ag assays, 23 negative sputum and serum samples and 64 pairs of sputum and serum from active smear-positive patients (PTM+) were tested. For antibody assay, 116 negative controls, 143 PTM+ and 54 extra-pulmonary tuberculosis patients were tested. RESULTS: The sensitivities of the APA antigen detection assays were low (less than 40%) for a specificity of 95.6%, using either monoclonal antibodies or clinical specimens. The anti-APA serology was more sensitive (76.9% for PTM+ patients) but less specific (73.2%). Due to their poor predictive values, these tests cannot be recommended for the routine diagnosis of tuberculosis in Madagascar.     

噬菌体裂解法与BACTEC-460法在结核分支杆菌快速检测中的比较

目的：比较噬菌体裂解法与BACTEC－460法在结核分支杆菌快速检测及鉴定中的价值。方法：应用噬菌体裂解法和BACTEC－460法分别检测30株结构分支杆菌临床分离株、10株非结核分支杆菌和7株非分支杆菌，以及60份临床确诊的肺结核患者的痰标本，结果：所有结核分支杆菌临床分离株噬菌体裂解试验均为阳性，而非结核分支杆菌和非分支杆菌均为阴性。41份BACTEC－460培养阳性和19份BACTEC－460培养阴性的痰标本中，噬菌体裂试验分别有34份（82．9％）和5份（26．3％）阳性。结论：噬菌体裂解法可以简便，快速地检测结核分支杆菌，并且具有较高的敏感性的特异性。     

内镜活检对肠结核的诊断价值

目的探讨结肠镜检查及其活检标本对肠结核的诊断价值。方法对高度怀疑肠结核的患者34例进行结肠镜、胸腹部X线、病理组织学和结核菌PCR试验检查，并比较其阳性率。结果34例患者最终确诊为肠结核的有23例、克罗崽病3例、结肠癌3例，其他疾病5例。在各疾病中的阳性率均无明显差异。腹部X线阳性率47．8％，假阳性27．3％；内镜诊断阳性率为52．2％，假阳性27．3％；活检组织病理学阳性率82．6％，假阳性9．1％；PCR阳性率73．9％，假阳性18．2％；PPD阳性率52．2％，假阳性9．1％，结论结肠镜检查诊断肠结核的阳性率不高，结肠镜活柃标本进行组织学和结核菌PCR检测可显著提高肠结核的诊断率，但要注意假阳性结果。     

Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear-negative pulmonary tuberculosis using a polymerase chain reaction assay

Abstract The objective of this study was to evaluate the utility of a polymerase chain reaction (PCR) assay in detecting Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) specimens of patients suspected of having active pulmonary tuberculosis (TB) but who were sputum smear-negative. Patients undergoing investigation for suspected pulmonary TB at the University Hospital, Kuala Lumpur, and who were sputum smear-negative underwent fibreoptic bronchoscopy and BAL. One portion of each lavage specimen was submitted for smear examination for acid-fast bacilli and mycobacterial culture and the other portion assayed by PCR for the presence of a 562-base pair DNA segment belonging to the insertion sequence IS986, unique to the M. tuberculosis complex. As controls, lavage specimens from patients with other lung lesions were also similarly tested. The PCR assay gave a positivity rate of 80.9% (55 of 68) compared with 8.8% of smear examination and 7.4% of culture for detecting M. tuberculosis in BAL specimens. The assay was positive in two of 45 BAL specimens from 35 control subjects. The PCR assay was more sensitive than smear and culture in detecting M. tuberculosis in BAL specimens of patients with sputum smear-negative pulmonary TB.     

结核分枝杆菌特异性38kD多肽抗原提纯及其血清学诊断价值的研究

目的提纯结核分枝杆菌特异38kD多肽抗原,建立基于38kD多肽抗原(P38)的斑点金免疫渗滤法(DIGFA)检测结核病人血清标本,评价38kD多肽用于结核病血清学诊断抗原的实际价值。方法采用超声破碎、SDS-PAGE、切胶浸泡回收法提取结核分枝杆菌H37Rv株的38kD多肽抗原。建立以38kD多肽为包被抗原的DIGFA(P38-DIGFA),并检测147例临床确诊的活动性肺结核病人血清标本。同时建立以结核分枝杆菌脂阿拉伯甘露糖(LAM)为包被抗原的DIGFA(LAM-DIGFA)作为对照。结果结核分枝杆菌H37Rv株38kD多肽抗原提取物经SDS-PAGE后仅显示为单一的条带,并可与临床确诊的肺结核病人阳性血清标本呈阳性免疫印迹反应。P38-DIGFA和LAM-DIGFA检测肺结核病人血清标本的总阳性率分别为84.4%(124/147)和76.2%(112/147),其中59份痰涂片及培养均阳性的肺结核病人血清标本P38-DIGFA和LAM-DIGFA阳性率分别为88.1%(52/59)和84.7%(50/59),88份痰涂片及培养均阴性的肺结核病人血清标本P38-DIGFA和LAM-DIGFA阳性率分别为81.8%(72/88)和70.5%(62/88),60例气管炎病人血清标本阳性率分别为13.3%(8/60)和6.7%(4/60),120例健康人血清标本阳性率分别为5.8%(7/120)和5.0%(6/120)。各P38-DIGFA和LAM-DIGFA检测阳性率之间均无显著性差异。结论结核分枝杆菌38kD多肽作为抗原用于结核病血清学检测时,其敏感性和特异性与LAM相似,可应用于研发结核病血清学诊断试剂盒。     

Sensitivity and specificity of a multi-antigen ELISA test for the serological diagnosis of tuberculosis.

A new serological assay (DETECT-TB, BioChem ImmunoSystems), using three recombinant proteins and two synthetic peptides for the detection of the anti-Mycobacterium tuberculosis IgG, was evaluated using a panel of serum specimens collected from 100 tuberculosis (TB) patients and 270 controls, in comparison with a homemade ELISA test using purified protein derivative (PPD) as antigen. DETECT-TB presented a higher sensitivity (75%) compared to PPD-ELISA (56%; P < 0.01), while the specificity of each assay was similar (DETECT-TB 97%; PPD-ELISA 100%; P > 0.80). Receiver operating characteristics (ROC) analysis obtained with these data confirmed the higher level of performance of DETECT-TB in comparison with PPD-ELISA. Considering the rapidity, cost-effectiveness and simplicity of this assay, its use may provide useful clinical information aiding in the rapid diagnosis of difficult TB cases.     

Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction

OBJECTIVES: It is difficult to differentiate intestinal tuberculosis from Crohn's disease because of similar clinical, pathological, radiological, and endoscopic findings. The purpose of this study was to investigate the value of polymerase chain reaction (PCR) assay in the differentiation intestinal tuberculosis from Crohn's disease, and compare the histopathological features of endoscopic biopsy of the two disorders. METHODS: A total of 39 endoscopic biopsy specimens from patients with intestinal tuberculosis and 30 specimens from patients with Crohn's disease were subjected to pathological analysis retrospectively, Ziehl-Neelsen stain, and PCR assay. RESULTS: Except for granuloma with caseation and confluence, which was the characteristic of intestinal tuberculosis, other pathological features of intestinal tuberculosis and Crohn's disease were very similar or were difficult to find in endoscopic biopsy specimens. The positivity rate by PCR in 39 intestinal tuberculosis specimens was 64.1% (25/39), but was zero by PCR in 30 Crohn's disease specimens. Moreover, in the tissues of intestinal tuberculosis with granulomas similar to those of Crohn's disease, there were 71.4% (10/14) positive by PCR, and there were 61.1% (11/18) positive in intestinal tuberculosis tissues without granulomas. CONCLUSIONS: Biopsy is of limited diagnostic value in the differentiation intestinal tuberculosis from Crohn's disease, and PCR is valuable in the differentiation between intestinal tuberculosis and Crohn's disease.