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): 453-458.doi: 10.3881/j.issn.1000-503X.2009.04.014

• 论著 • 上一篇    下一篇

多种诊断技术在全身播散性结核病诊治中的联合应用

张峣1;刘晓清1;张丽帆1;朱朝晖2;赵智贤3   

  1. 中国医学科学院北京协和医学院北京协和医院 1感染科 2PET中心, 北京100730
    3生物芯片北京国家工程研究中心, 北京100084
  • 收稿日期:2009-05-19 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: 刘晓清

Combined Application of Enzyme-linked Immunospot Assay, Positron Emission Tomography, and Gene Chip Assay in the Diagnosis of A Case of Chronic Disseminated Tuberculosis

ZHANG Yao1; LIU Xiao-qing1;ZHANG Li-fan1;ZHU Zhao-hui2;ZHAO Zhi-xian3   

  1. 1Department of Infectious Diseases,2PET Center,PUMC Hospital,CAMS and PUMC, Beijing 100730,China
    3National Biochip Center of China, Beijing 100084,China
  • Received:2009-05-19 Revised:1900-01-01 Online:2009-08-30 Published:2009-08-30
  • Contact: LIU Xiao-qing

摘要: 摘要:目的 探讨结核特异的γ干扰素释放分析T-SPOT.TB、CT联合正电子发射断层显像(PET/CT)和基因芯片分析在诊断播散性结核病中的应用,探讨播散性结核病的诊治要点。方法 分析北京协和医院感染科收治的1例慢性全身播散性结核病患者的临床诊治情况,以及其T-SPOT.TB、PET/CT和基因芯片分析的结果。结果 患者临床符合慢性结核病表现,外周血T-SPOT.TB检测显示结核特异性抗原即6kD早期分泌靶向抗原和10kD培养滤过蛋白肽段库刺激后释放γ干扰素的T细胞分别为:3908 和 3400 斑点形成细胞(SFCs)/106外周血单个核细胞(PBMCs)。全身PET/CT检查显示全身多发放射性摄取增高病变,累及双肺、淋巴结和骨骼,行淋巴结、肺部、右髂后上嵴活检,病理显示为肉芽肿病变。组织培养为分枝杆菌,基因芯片分析确定为结核分枝杆菌,对利福平和异烟肼敏感。抗结核治疗后患者症状缓解,体温正常,治疗10周后T-SPOT.TB检测显示6kD早期分泌靶向抗原和10kD培养滤过蛋白肽段库刺激后释放γ干扰素的T细胞分别为:1528SFCs/106PBMCs、1460SFCs/106PBMCs,较治疗前显著下降。结论 播散性结核病的及时诊断有赖于对该病的充分了解和重视。T-SPOT.TB、PET/CT和基因芯片技术的合理应用有助于播散性结核病的诊治。

关键词: 播散性结核病, T-SPOT.TB, γ干扰素释放分析, 正电子发射断层显像, 基因芯片分析

Abstract: ABSTRACT:Objective To highlight the clinical features and diagnosis of chronic disseminated tuberculosis, with emphasizing the usefulness of several recently available diagnostic technologies in this setting. MethodWe presented a case of chronic disseminated tuberculosis diagnosed with the combined application of interferon-gamma release assay T-SPOT.TB,18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET),and gene chip assay. Results A 53-year-old gentleman who had chronic cough for 7 years and fever for 2 weeks was referred to our hospital for further evaluation.18F-FDG-PET/CT scan showed increased FDG uptake in multiple lesions involving bilateral lungs, supraclavicular, mediastinal and intro-abdominal lymph nodes and bones, mimicking metastatic malignancy. T-SPOT.TB assay revealed significant responses [early secreting antigen target 6(ESAT-6):3908spot forming cells (SFCs)/106 peripheral blood mononuclear cells (PBMCs),culture filtrate protein (CFP-10):3400SFCs/106 PBMCs]. Subsequent biopsy of supraclavicular lymph node, lung, and ilium revealed granulomas, while culture of the obtained tissue yeilded mycobacteria. Gene chip testing identified M.tuberculosis sensitive to isoniazid and rifampin. After 10 weeks of treatment for tuberculosis, the patients condition was improved and a second T-SPOT.TB assay showed significantly reduced responses(ESAT-6:1528SFCs/106 PBMCs; CFP-10:1460SFCs/106 PBMCs). Conclusions Timely diagnosis of chronic disseminated tuberculosis requires high index of suspicion. T-SPOT.TB assay, PET/CT, and gene chip assay may provide valuable information that facilitates further diagnostic procedures and treatment decision.

Key words: disseminated tuberculosis, t-spot.tb, interferon-camma release assay, positron emission tomocrapdy, cene cdip assay