摘要
目的观察活动性与非活动性肺结核患者血清新蝶呤(neopterin,NP)、抗脂阿拉伯甘露糖(lipoarabinomannan,LAM)抗体血清标志物和结核感染T细胞斑点试验(T-cell spot test of tuberculosis,T-SPOT.TB)方法在肺结核活动性鉴别中的价值。方法选取自2019年1月至12徐州市传染病医院收治的104例肺结核患者为研究对象,参考《肺结核活动性判断规范及临床应用专家共识》标准分为活动性组(48例)和非活动性组(56例)。另选取同期于我院进行体检的健康人作为对照组(50例)。采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)进行血清NP、抗LAM抗体检测,采用酶联免疫斑点试验(enzyme-linked immunospot assay,ELISPOT)检测T-SPOT.TB。分析各组血清NP、抗LAM抗体、T-SPOT.TB的表达差异,并采用ROC曲线法分析血清NP、抗LAM抗体、T-SPOT.TB在肺结核活动性鉴别中的价值。结果活动组、非活动性组、对照组血清NP、抗LAM抗体、血清T-SPOT.TB表达水平均依次下降,组间差异有统计学意义[NP:(26.54±2.67)nmol/L比(20.69±2.19)nmol/L比(6.84±1.33)nmol/L,抗LAM抗体:(46.26±6.71)nmol/L比(30.17±5.38)nmol/L比(14.19±4.03)nmol/L,T-SPOT.TB:(109.73±10.80)nmol/L比(82.34±8.32)nmol/L比(57.44±6.49)nmol/L,F值分别为68.172,134.778和223.619,P值均<0.05]。血清NP、抗LAM抗体、T-SPOT.TB联合鉴别肺结核活动性的敏感性,特异性和准确率分别为86.83%、84.79%和89.07%,均高于单独血清NP、抗LAM抗体、T-SPOT.TB鉴别检测肺结核活动性的敏感性(79.43%,77.64%,73.84%)、特异性(80.32%,78.43%,74.56%)和准确率(75.52%,73.24%,70.73%)。结论肺结核患者存在明显血清NP、抗LAM抗体、T-SPOT.TB水平异常,相比于血清NP、抗LAM抗体和T-SPOT.TB的单独指标检测,三项指标联合检测在肺结核活动性鉴别中的效能更佳。
Objective To observe the value of serum neopterin(NP),anti-lipoarabinomannan(LAM)antibody,and T-cell spot test of tuberculosis(T-SPOT.TB)in the identification of active pulmonary tuberculosis.Methods A total of 104 patients with pulmonary tuberculosis admitted to Xuzhou Infectious Disease Hospital from January to December 2019 were selected as the research objects and were divided into the active group(48 cases)and the inactive group(56 cases)according to the standard of"Expert Consensus on Judging the Activity and Clinical Application of Tuberculosis".In addition,50 healthy people who received physical examination in the hospital during the same period were selected as the control group.Enzyme linked immunosorbent assay(ELISA)was used to detect serum NP and anti-LAM antibody.T-SPOT.TB were detected by enzyme-linked immunospot assay(ELISPOT).The expression differences of serum NP,anti-LAM antibody and T-SPOT.TB in each group were analyzed,and the value of serum NP,anti-LAM antibody and T-SPOT.TB in the identification of active pulmonary tuberculosis was also analyzed by ROC curve.Results The serum NP,anti-LAM antibody,and serum T-SPOT.TB in the active group,inactive group,and control group were decreased sequentially,and the differences among the groups were statistically significant[NP:(26.54±2.67)nmol/L vs(20.69±2.19)nmol/L vs(6.84±1.33)nmol/L,anti-LAM antibody:(46.26±6.71)nmol/L vs(30.17±5.38)nmol/L vs(14.19±4.03)nmol/L,T-SPOT.TB:(109.73±10.80)nmol/L vs(82.34±8.32)nmol/L vs(57.44±6.49)nmol/L,F values were 68.172,134.778 and 223.619 respectively,all P values<0.05].The sensitivity,specificity and accuracy of combined detection of serum NP,anti-LAM antibody and T-SPOT.TB were 86.83%,84.79% and 89.07%respectively,which were higher than those of single detection of sensitivity(79.43%,77.64%,73.84%),specificity(80.32%,78.43%,74.56%)and accuracy(75.52%,73.24%,70.73%).Conclusion The levels of serum NP,anti-LAM antibody and T-SPOT.TB were significantly abnormal in patients with pulmonary tuberculosis.Compared with the single detection of serum NP,anti-LAM antibody and T-SPOT.TB,the combined detection of these indicators is more effective in the identification of active pulmonary tuberculosis.
作者
孙启伟
刘娇蓉
Sun Qiwei;Liu Jiaorong(Infections Diseases Department,Xuzhou Infectious Disease Hospital,Xuzhou 221000,China)
出处
《国际免疫学杂志》
CAS
2021年第5期530-535,共6页
International Journal of Immunology
