论文部分内容阅读
目的探讨ELISPOT在结核病诊断中的应用价值。方法分离TB患者54例和非TB患者52例的外周血单个核淋巴细胞,并采用以结核分枝杆菌特异性蛋白ESAT-6和CFP-10为抗原的ELISPOT试验技术进行结核分枝杆菌(Mtb)特异性T淋巴细胞免疫反应的检测,同时做痰涂片、痰培养、PPD试验和胶体金法检测。以临床明确诊断为标准,比较分析评价不同检测方法的敏感度和特异度。结果 TB-ELISPOT的敏感度(Se)90.7%、特异度(Sp)96.15%、阳性预测值(PPV)0.96、阴性预测值(NPV)0.91、阳性似然比(+LR)23.55和阴性似然比(-LR)0.1;胶体金法的Se 59.26%、Sp 88.46%、PPV0.84、NPV 0.68、+LR 5.14和-LR 0.46;PPD试验的Se 64.81%、Sp 82.69%、PPV 0.80、NPV 3.74、+LR 0.69和-LR 0.43;痰涂片的Se 40.74%、Sp 100.00%、PPV 1.0、NPV 0.62、+LR>10和-LR0.52;痰培养的Se 25.93%、Sp 100.00%、PPV 1.0、NPV 0.57、+LR>10和-LR0.77。统计结果显示ELISPOT检测的敏感度明显高于其它常用结核病诊断方法。ELISPOT在痰涂片和痰培养阴性的TB患者中的阳性检出率分别为84.38%和87.5%。结论 ELISPOT是一种敏感度和特异度均较高的结核病免疫学辅助诊断方法,有助于提高诊断结核感染的阳性检出率,且耗时短,可作为临床结核病诊断尤其是菌阴结核病的重要辅助手段之一,具有较高的临床推广价值。
Objective To explore the value of ELISPOT in the diagnosis of tuberculosis. Methods Peripheral blood mononuclear lymphocytes were isolated from 54 patients with TB and 52 patients with non-TB, and Mycobacterium tuberculosis (Mtb) was isolated using ELISPOT assay with Mycobacterium tuberculosis specific protein ESAT-6 and CFP-10 as antigen ) Specific T lymphocyte immune response detection, sputum smear, sputum culture, PPD test and colloidal gold assay. To a clear clinical diagnosis as the standard, comparative analysis to evaluate the sensitivity and specificity of different detection methods. Results The sensitivity and specificity of TB-ELISPOT were 90.7%, 96.15%, PPV 0.96, NPV 0.91, + LR 23.55 and negative likelihood (-LR) 0.1; Se 59.26%, Sp 88.46%, PPV 0.84, NPV 0.68, + LR 5.14 and -LR 0.46 in the colloidal gold method; Se 64.81%, Sp 82.69%, PPV 0.80, NPV 3.74 , + LR 0.69 and -LR 0.43; Se 40.74%, Sp 100.00%, PPV 1.0, NPV 0.62, + LR> 10 and -LR 0.52 in sputum smear; Se 25.93%, Sp 100.00% , NPV 0.57, + LR> 10 and -LR 0.77. Statistical results show that ELISPOT detection sensitivity was significantly higher than other commonly used methods of diagnosis of tuberculosis. The positive detection rates of ELISPOT in sputum smear and sputum culture negative TB patients were 84.38% and 87.5% respectively. Conclusion ELISPOT is a highly sensitive and specific method for the diagnosis of tuberculosis. It is helpful to improve the positive detection rate of TB infection and short time-consuming. It can be used as a clinical diagnosis of tuberculosis, especially TB One of the important auxiliary means, has higher clinical promotion value.