摘要
目的探讨3种结核分枝杆菌抗原刺激后外周血单个核细胞(PBMC)γ干扰素(IFNγ)释放反应对结核性感染和结核病的诊断意义。方法获取活动性结核病患者(结核组,57例)、肺癌患者(肺癌组,29例)和健康人(健康对照组,27名)外周血单个核细胞。分别将结核分枝杆菌纯蛋白衍生物(PPD)、结核分枝杆菌早期分泌抗原靶6000蛋白(ESAT6)和38000抗原与PBMC共培养5d,采用酶联免疫吸附测定(ELISA)法检测培养上清液中IFNγ浓度。比较3种抗原PBMCIFNγ释放水平和PPD皮试(TST)结果。结果(1)健康对照组TST反应与BCG接种史及排菌患者接触密切程度经Logistic回归分析显示均呈正相关(P=0.047和P=0.041);以ESAT6为抗原的PBMCIFNγ释放水平与结核病患者接触密切程度相关(P=0.005),而与BCG接种史无明显相关性。(2)3组间TST结果差异无显著性。(3)以38000抗原刺激后IFNγ释放水平为观察指标,经受试者操作特性(ROC)曲线分析获得最佳域值为1000pg/ml,以此判断38000抗原刺激后IFNγ释放水平诊断结核病敏感性为64.9%,特异性为89.3%,准确性为77.0%,阳性预测值为86.0%,阴性预测值为71.0%。结论ESAT6抗原的IFNγ释放反应对结核分枝杆菌感染的诊断意义优于TST,38000抗原刺激后IFNγ释放反应对结核病的临床诊断有辅助意义。
Objective To investigate the in-vitro interferon-gamma （IFN-γ）release assay based on three different Mycobacterium tuberculosis antigens in the diagnosis of tuberculosis and Mycobacterium tuberculosis infections. Methods The peripheral blood mononuclear cells （PBMC） were collected from the patients with tuberculosis （ tuberculosis group, n = 57 ）, patients with lung cancer （ lung cancer group, n = 29）, and healthy controls （ healthy control group 2, n = 27）. The PBMCs were co-cultured for 5 days with different antigens： purified protein derivatives （PPD） of tuberculin, early secretary antigenic target 6 000 protein （ESAT6）and 38 000 antigen, The protein levels of IFN-γ were detected by ELISA, and the results were compared to those with the tuberculin skin test （TST）. Results （ 1 ） For healthy controls, the TST was positively related to the history of BCG vaccination and the closeness of contact with sputum-posltive tuberculosis patients （P =0. 047, P =0. 041 respectively）. The ESAT6 based IFN-γ release assay was only significantly related to the closeness of contact with sputum-positive tuberculosis patients （ P = 0. 005 ）, but not to the history of BCG vaccination. （2）There was no significant difference of the TST results among the three groups （ P 〉 0.05 ）. （ 3 ） The receiver operating characteristic （ROC） curve analysis indicated that the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the IFN-γ release assay based on 38 000 antigen were 64.9%, 89.3%, 77.0% , 86. 0%, and 71.0% respectively for the diagnosis of tuberculosis. Conclusions IFN-γ release assay based on ESAT6 appears to be better than TST in the diagnosis of infection of Mycobacterium tuberculosis, while IFN-γ release assay based on 38 000 may be helpful for the diagnosis of tuberculosis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2005年第8期545-549,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
首都医学发展基金资助项目(20023063)
