摘要
目的探讨检测患者肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中的效应T细胞对涂阴肺结核快速诊断价值。方法收集2016-2017年在南通市第六人民医院结核科住院的120例疑似肺结核患者的BALF,经确诊后分为涂阳肺结核组43例、涂阴肺结核组56例,非结核感染组21例。利用结核感染效应T细胞斑点试验(T-SPOT)对所有患者的BALF中的效应T细胞进行检测,评估其阳性率;收集涂阴组患者BALF其他结核检测指标:结核分枝杆菌RNA恒温扩增实时荧光检测技术(SAT-TB)、使用BACTEC MGIT 960系统的结核分枝杆菌快速培养(960培养)、利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)及外周血T-SPOT检测,与BALF T-SPOT进行对比,并计算BALF T-SPOT对于涂阴肺结核的诊断价值。结果涂阳组和涂阴组BALF T-SPOT阳性率无明显差异(χ~2=0.677,P>0.05),但均明显高于非结核组(C2=51.325和51.889,P<0.05)。涂阴肺结核患者BALF T-SPOT检测的ROC曲线下面积为0.932,诊断准确度较高。涂阴患者BALF T-SPOT的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为91.1%、95.2%、98.1%、80%,阳性率明显高于其他结核检测指标。结论利用T-SPOT技术检测BALF中效应性T细胞对于快速诊断涂阴肺结核有较高的临床实用价值。
Objective To explore the value of bronchoalveolar lavage fluid(BALF)effector T-cell assay for the rapid diagnosis of smear-negative pulmonary tuberculosis.Methods Bronchoalveolar lavage fluid of 120 suspected pulmonary tuberculosis patients hospitalized from 2016 to 2017 was collected.After diagnosis,they were divided into the smear-positive pulmonary tuberculosis group(43 cases),the smear-negative pulmonary tuberculosis group(56 cases),and the non tuberculosis infection group(21 cases).All patients were detected in BALF effector T cells by using T-SPOT.TB assay,to evaluate the positive rate.Other tuberculosis tests included simultaneous amplification and testing for Mycobacterium tuberculosis,MGIT 960,Xpert Mycobacterium tuberculosis/rifampin assay and peripheral blood T-SPOT.The value of BALF T-SPOT for the diagnosis of smear-negative tuberculosis was calculated.Results There was no significant difference in the positive rate of BALF T-SPOT between the smear-positive group and the smear-negative group(χ^2=0.677,P>0.05),but all were significantly higher than those in the non tuberculosis group(2=51.325 and 51.889,P<0.05).The area under the ROC curve of BALF T-SPOT in smear-negative patients was 0.932,and the diagnostic accuracy was higher.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of BALF T-SPOT in smear-negative patients were respectively 91.1%,95.2%,98.1%,80%,and the positive rate was significantly higher than that of other tuberculosis tests.Conclusion The use of T-SPOT to detect the effector T cells in alveolar lavage fluid is of high clinical value for the rapid diagnosis of smear-negative pulmonary tuberculosis.
作者
王琳
施军卫
陈俊林
陈晓丽
秦志华
郑宏
唐建美
WANG Lin;SHI Jun-wei;CHEN Jun-lin;CHEN Xiao-li;QIN Zhi-hua;ZHENG Hong;TANG Jian-mei(the Sixth People's Hospital of Nantong,Nantong,Jangsu 226011,China)
出处
《临床肺科杂志》
2019年第4期588-591,共4页
Journal of Clinical Pulmonary Medicine
基金
南通市卫生局青年基金课题(No WQ2015058)
关键词
肺泡灌洗液
涂阴肺结核
T-SPOT
诊断
bronchoalveolar lavage
smear-negative pulmonary tuberculosis
T-SPOT
diagnosis
