不同结核分支杆菌抗原对结核病的诊断价值

目的　研究不同结核分支杆菌单体蛋白抗原在结核病体液免疫诊断中的价值。方法以快速免疫色谱法（ＩＣＴＴＢ卡） 检测结核分支杆菌５ 种单体蛋白的抗原性，观察其在结核病诊断中的敏感性和特异性，并与ＰＰＤ 皮试及脂阿拉伯糖甘露糖（ＬＡＭ） 相比较。结果　ＩＣＴＴＢ 卡、ＬＡＭ 及ＰＰＤ皮试诊断结核病的敏感性分别为５５．９％ 、５２．６％ 、７５．０％ ，后者与前二者间差异均有显著意义（ Ｐ＜０ ．０５）；ＩＣＴＴＢ卡、ＬＡＭ、ＰＰＤ皮试诊断肺结核的特异性为８７ ．６％ 、６２．９％ 、６８．９％ ，前者与后二者间差异均有非常显著意义（ Ｐ＜ ０．０１）；ＩＣＴＴＢ卡诊断肺结核病的临床阳性预计值为８８ ．５％ ，临床阴性预计值为５３ ．８ ％ ；非结核病例中的ＩＣＴＴＢ阳性主要由抗原４、５ 阳性所致，如果去除抗原４ 、５，那么ＩＣＴＴＢ诊断结核病的特异性将提高到９８．９％ 。结论　血清结核分支杆菌单体蛋白抗原性的测定是肺结核病一项有用的辅助诊断手段。

Clinical significance of different mycobacterial antigens in diagnosis of tuberculosis

Objective To evaluate the significance of different mycobacterial antigens in diagnosis of tuberculosis. Methods The sensitivity and specificity of 5 mycobacterial recombinant proteins in diagnosis of tuberculosis were observed by using ICT TB card and the results of ICT TB card were compared with PPD skin test and LAM. Results The sensitivities of ICT TB card,LAM and PPD skin test in diagnosis of pulmonary tuberculosis were 55.9%,52.6% and 75.0% respectively. There was statistically significant difference between the latter and the other two ( P <0.05). The specificities of ICT TB card,LAM and PPD skin test in diagnosis of pulmonary tuberculosis were 87.6%,62.9% and 68.9% respectively. There was statistically significant difference between the former and the other two. The clinical positive predictive value in diagnosis of pulmonary tuberculosis was 88.5%; the clinical negative predictive value was 53.8%. The positive reactions of ICT TB in non tuberculosis were caused mainly by antigens 4,5, and if antigens 4,5 were excluded, the specificity of ICT TB card rose to 98.9%. Conclusions The results suggested that measuring mycobacterial recombinant proteins was a useful supplementary tool for diagnosis of pulmonary tuberculosis.