【摘要】 目的探讨肺结核活动程度对结核感染T细胞斑点试验反应强度的影响。方法选取2018年6月至12月期间在昆明市第三人民医院结核二科400例活动性肺结核患者,所有患者均进行了结核感染T细胞斑点试验(T-SPOT.TB),对比分析活动性肺结核患者,在不同病情状态下,T-SPOT.TB的免疫强度。结果 180例病原学阳性肺结核,T-SPOT.TB阳性率为96.1%(173/180);220例病原学阴性肺结核,T-SPOT.TB阳性率86.4%(190/220),两者χ~2检验比较差异有统计学意义(χ~2=11.205,P=0.001<0.05);两组中抗原ESAT-6阳性率比较差异有统计学意义(χ~2=12.753,P=0.000<0.05),抗原CFP-10阳性率比较差异无统计学意义(χ~2=2.482,P=0.115>0.05)。病原学阳性且T-SPOT.TB阳性173例肺结核患者中,按照抗酸杆菌涂片量(1条～1+、2+、3+、4+)进行分组比较,4组抗原ESAT-6、CFP-10进行比较,差异无统计学意义(P=0.792,0.595,均>0.05);按治疗史分为初治、复治肺结核,两组间抗原ESAT-6、CFP-10比较,其中抗原ESAT-6在初、复治肺结核比较中有统计学差异(Z=-2.178 P=0.005<0.05),抗原CFP-10比较无统计学差异(Z=-0.856,P=0.392>0.05);按照耐药状况分非耐药、耐药肺结核,两组间抗原ESAT-6、CFP-10比较无统计学差异(P=0.748,0.845,均>0.05)。结论结核感染T细胞斑点试验对诊断活动性肺结核的敏感性较好,利用其应答强度反映结核感染活动程度有一定临床意义。更多还原

【Abstract】 Objective To investigate the effect of the activity of tuberculosis on the response intensity of T cell spot test for tuberculosis infection(T-SPOT.TB). Methods From June to December 2018, 400 patients with active tuberculosis receiving T-SPOT.TB in the No. 2 Department of Tuberculosis in the Third People’s Hospital of Kunming were selected. The immunization intensity of T-SPOT.TB in patients with active tuberculosis was comparatively analyzed under the different conditions. Results A total of 180 patients showed pathogenic positive tuberculosis, with the positive rate of T-SPOT.TB being 96.1%(173/180), and the other 220 patients had pathogenic negative tuberculosis, with the positive rate of T-SPOT.TB being 86.4%(190/220), presenting a statistical difference by the Chi-square test (χ~2= 11.205, P = 0.001 < 0.05). A statistical difference was found in the positive rate of antigen ESAT-6 between the two groups (χ~2= 12.753,P = 0.000 < 0.05),but not in the positive rate of antigen CFP-10 (χ~2= 2.482,P = 0.115 > 0.05). Among 173 patients with pathogenic positive and T-SPOT.TB-positive tuberculosis, antigens ESAT-6 and CFP-10 showed no statistical differences based on the amount of acid-fast bacilli smear(1～1 +, 2 +, 3 + and 4 +)(P = 0.792 and 0.595, both P > 0.05).According to the history of treatment, the patients were divided into both the primary treatment and retreatment groups. A statistical difference was found in ESAT-6(Z =-2.178,P = 0.005 < 0.05) but not in CFP-10(Z =-0.856, P = 0.392 > 0.05) between the primary treatment and retreatment groups. ESAT-6 and CFP-10 demonstrated no statistical differences between the patients with non-drug-resistant and drug-resistant tuberculosis(P = 0.748 and 0.845, both > 0.05). Conclusion The sensitivity of T-SPOT.TB in the diagnosis of active tuberculosis is high. It is of certain clinical significance to use its response intensity to reflect the activity of tuberculosis infection.更多还原