中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2009, Vol. 31 ›› Issue (4): 443-448.doi: 10.3881/j.issn.1000-503X.2009.04.012

• 论著 • 上一篇    下一篇

酶联免疫斑点检测和结核菌素试验在初治肺结核中的辅助诊断价值

刘菲1; 张宗德2; 操敏1; 马丽萍1; 高孟秋1;吴晓光1;朱莉贞1;马玙1   

  1. 北京市结核病胸部肿瘤研究所 1结核科 2结核病分子生物学研究室,北京 101149
  • 收稿日期:2009-03-05 修回日期:1900-01-01 出版日期:2009-08-30 发布日期:2009-08-30
  • 通讯作者: 张宗德

Role of Enzyme-linked Immunospot Assay and Tuberculin Skin Test in the Auxiliary Diagnosis of Initial Pulmonary Tuberculosis

LIU Fei1;ZHANG Zong-de2;CAO Min1; MA Li-ping1; GAO Meng-qiu1;WU Xiao-guang1;ZHU Li-zhen1; MA Yu1   

  1. 1Department of Tuberculosis,2Laboratory of Molecular Biology for Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
  • Received:2009-03-05 Revised:1900-01-01 Online:2009-08-30 Published:2009-08-30
  • Contact: ZHANG Zong-de

摘要: 摘要:目的 比较酶联免疫斑点检测(ELISPOT)和结核菌素试验(TST),探讨ELISPOT在初治肺结核中的辅助诊断价值。 方法选取初治肺结核123例和非结核疾病病例102例作为结核组和对照组,应用6kD早期分泌靶向抗原/10kD培养滤过蛋白融合蛋白(ESAT-6/CFP-10)作为抗原对受试者外周血单个核细胞进行ELISPOT(即ESAT-6/CFP-10-ELISPOT),检测斑点形成细胞(SFCs)的数量;同时对受试者行TST。结果 结核组ESAT-6/CFP-10-ELISPOT形成的SFCs数显著高于对照组(P=0.000)。结核组中ESAT-6/CFP-10-ELISPOT的敏感度91.1%(111/123)、特异度80.4%(82/102)、阳性似然比4.60、阴性似然比0.12、阳性预测值0.85、阴性预测值0.87,TST的敏感度65.6%(59/90)、特异度45.1%(46/102) 、阳性似然比1.31、阴性似然比0.76、阳性预测值0.51、阴性预测值0.60。 ESAT-6/CFP-10-ELISPOT的敏感度和特异度显著高于TST(均P=0.000)。 菌阳肺结核组和菌阴肺结核组间ESAT-6/CFP-10-ELISPOT形成SFCs数量差异无显著性 (P=0.166),两组ESAT-6/CFP-10-ELISPOT的敏感度分别为91.8%(67/73)和88.0%(44/50),二者比较差异无显著性(P=0.448)。结论 ESAT-6/CFP-10-ELISPOT有可能作为辅助诊断初治肺结核的较为准确方法,并为菌阴肺结核提供一定的诊断依据,但诊断的特异度可能受结核潜伏感染影响。TST对初治肺结核的诊断价值较小。

关键词: 酶联免疫斑点技术, 结核菌素试验, 辅助诊断, 初治肺结核

Abstract: ABSTRACT:Objective To compare enzyme-linked immunospot assay (ELISPOT) and tuberculin skin test (TST) and explore their roles in the auxiliary diagnosis of initial pulmonary tuberculosis. Methods Totally 123 patients with initial pulmonary tuberculosis (tuberculosis group) and 102 patients with non-tuberculosis pulmonary disease (control group) were enrolled. The peripheral blood mononuclear cells of all participants were co-cultured with early secretiny antigen target-6/culture filtrate protein-10 fusion protein (ESAT-6/CFP-10 ), and spot forming cells (SFCs) were enumerated by ELISPOT (ESAT-6/CFP-10-ELISPOT). TST was also performed simultaneously. Results ESAT-6/CFP-10-ELISPOT showed significantly higher numbers of SFCs after stimulation in tuberculosis group than in control group (P=0.000). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of ESAT-6/CFP-10-ELISPOT were 91.1% (111/123), 81.4% (82/102),4.60, 0.12, 0.85, and 0.87 respectively, while the above values of TST were 65.6%(59/90), 45.1% (46/102),1.31, 0.76, 0.51, and 0.60, respectively. The sensitivity and specificity of ESAT-6/CFP-10-ELISPOT were significantly higher than those of TST(all P=0.000). The number of SFCs were not significantly different between smear-positive tuberculosis subgroup and smear-negative tuberculosis subgroup (P=0.166). The sensitivities were 91.8%(67/73) and 88.0%(44/50) in these two subgroups, respectively, (P=0.448). Conclusions ESAT-6/CFP-10-ELISPOT may be a more accurate approach for the auxiliary diagnosis of initial pulmonary tuberculosis; meanwhile, it offers certain diagnostic evidences for smear-negative tuberculosis. However, its specificity may be affected by latent tuberculosis infection. On the contrary, TST has poor value in the auxiliary diagnosis of initial pulmonary tuberculosis.

Key words: enzyme-linked immunospot assay, tuberculin skin test, auxiliary diacnosis, initial pulmonary tuberculosis