本文選題：活動性結核病　切入點：結核抗體　出處：《新鄉(xiāng)醫(yī)學院》2014年碩士論文　論文類型：學位論文

【摘要】：背景近年來隨著結核病基礎研究的迅速發(fā)展,在免疫學檢測方面已先后開展了一些較為可靠的結核病檢測方法,尤其近年研發(fā)的一種新技術——結核感染T細胞斑點試驗(T-SPOT.TB),已在許多歐美國家得到認可并被應用于臨床診斷。但在我國由于存在較高的結核潛伏感染率,對于此種檢測方法在結核病診斷中的應用仍存在爭議,因此我們進行以下研究來進一步評價T-SPOT.TB在結核病診斷中的應用價值。目的通過將T-SPOT.TB分別與血清結核抗體檢測、皮膚結核菌素試驗在疑診活動性結核病患者中的檢測結果進行比較分析,并比較活動性結核患者與結核潛伏感染者T-SPOT.TB陽性結果的斑點數(shù),來評價T-SPOT.TB在結核病診斷中的應用價值。方法前瞻性納入2013年3月至2013年11月新鄉(xiāng)醫(yī)學院第一附屬醫(yī)院住院患者中疑診活動性結核病的患者167例,進行T-SPOT.TB、血清結核抗體、結核菌素試驗檢測。依據(jù)輔助檢查結果、臨床療效觀察及長時間隨訪結果等依據(jù)最終確定診斷,將上述三項檢測結果與最終臨床診斷相對比,以敏感性、特異性、陽性似然比、陰性似然比、符合率、陽性預測值、陰性預測值為評價指標,將T-SPOT.TB分別與血清結核抗體、皮膚結核菌素試驗進行比較。分別分析年齡、營養(yǎng)不良及重癥結核對T-SPOT.TB敏感性的影響。統(tǒng)計活動性結核患者與結核潛伏感染者T-SPOT.TB陽性結果斑點數(shù)并進行比較分析。結果(1)T-SPOT.TB、吉核抗體檢測、結核菌素試驗的敏感性分別為90%、28%、55%,T-SPOT.TB分別與另兩項檢測方法相比,差異有統(tǒng)計學意義(P0.001)(2)T-SPOT.TB、結核抗體檢測、結核菌素試驗的特異性分別為81.3%、79.1%、76.9%, T-SPOT.TB分別與另兩項檢測方法相比,差異無統(tǒng)計學意義(PO.05)。(3) T-SPOT.TB、結核抗體檢測、結核菌素試驗的陽性似然比分別為4.813、1.34、2.38,陰性似然比分別為0.12、0.91、0.59,T-SPOT.TB的陽性似然比最高,陰性似然比最低。(4) T-SPOT.TB、結核抗體檢測、結核菌素試驗符合率分別為84.8%、58.9%、68.2%, T-SPOT.TB分別與另兩項檢測方法相比,差異有統(tǒng)計學意義(P0.05)。(5) T-SPOT.TB、結核抗體檢測、結核菌素試驗的陽性預測值分別為76%、47%、61%, T-SPOT.TB與結核抗體檢測相比存在統(tǒng)計學差(P0.05),與結核菌素試驗相比無統(tǒng)計學差異(PO.05)。(6) T-SPOT.T B、結核抗體檢測、結核菌素試驗的陰性預測值分別為93%、62.6%、72.7% 。 T-SPOT.TB分別與另兩項檢測方法相比,差異有統(tǒng)計學意義(PO.001)。(7)營養(yǎng)不良組與無營養(yǎng)不良組、老年組與非老年組、重癥結核組與非重癥結核組T-SPOT.TB敏感性比較均無統(tǒng)計學差異(P0.05)。(8)活動性結核患者與結核潛伏感染者T-SPOT.TB陽性結果抗原A孔斑點中位數(shù)分別為21與14,二者比較無統(tǒng)計學差異(P0.05),抗原B孔斑點數(shù)中位數(shù)分別為25與3,二者比較有統(tǒng)計學差異(PO.05)結論T-SPOT.TB是一種診斷結核病的較好方法,陰性結果對排除活動性結核病的診斷價值較高。陽性結果對判斷結核是否活動作用有限。
[Abstract]:Background with the rapid development of basic research on tuberculosis in recent years, some reliable methods of tuberculosis detection have been carried out in immunology. In particular, a new technique developed in recent years-T-SPOT.TBX, has been recognized in many European and American countries and has been used in clinical diagnosis. However, because of the high latent infection rate of TB in China, The application of T-SPOT.TB in the diagnosis of tuberculosis is still controversial, so we do the following research to further evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. The results of skin tuberculin test in suspected active tuberculosis patients were compared, and the number of T-SPOT.TB positive spots in active tuberculosis patients and latent tuberculosis patients were compared. To evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. Methods from March 2013 to November 2013, 167 patients with suspected active tuberculosis were included in the first affiliated Hospital of Xinxiang Medical College. According to the results of auxiliary examination, clinical efficacy observation and long-term follow-up, the final diagnosis was determined. The results of the above three tests were compared with the final clinical diagnosis, with sensitivity, specificity, positive likelihood ratio, etc. Negative likelihood ratio, coincidence rate, positive predictive value and negative predictive value were evaluated. T-SPOT.TB was compared with serum tuberculosis antibody and skin tuberculin test. Effects of malnutrition and severe tuberculosis on T-SPOT.TB susceptibility. The number of T-SPOT.TB positive spots in active TB patients and latent TB patients were analyzed and compared. The sensitivity of the tuberculin test was 90%. The sensitivity of the TSPOT.TB test was significantly higher than that of the other two methods. The specificity of the TB antibody test was 81.3% and 79.1%, respectively, and the T-SPOT.TB test was compared with the other two methods, respectively, and the specificity of the tuberculin test was 79.9%. The T-SPOT.TB test was compared with the other two methods. There was no significant difference in T-SPOT.TB. the positive likelihood ratio of tuberculin test was 4.8131.34 ~ 2.38, and the negative likelihood ratio was 0.120.91 ~ 0.59% T-SPOT.TB was the highest, and the negative likelihood ratio was the lowest) T-SPOT.TB, TB antibody test, TB antibody test, T-SPOT.TB, TB antibody test, the positive likelihood ratio of T-SPOT.TB was the highest, the negative likelihood ratio was the lowest, and the positive likelihood ratio of TB antibody test was 4.8131.34, and the negative likelihood ratio of T-SPOT.TB was the highest and the lowest. The coincidence rates of tuberculin test were 84.8% and 58.9%, respectively. Compared with the other two methods, T-SPOT.TB was significantly different from the other two methods. The positive predictive values of the tuberculin test were 76 and 4761.The T-SPOT.TB was significantly lower than the tuberculosis antibody test (P0.05), and there was no statistical difference compared with the tuberculin test (P < 0.05. 0. 6) T-SPOT.TB. The negative predictive values of tuberculin test were 93.62.6% and 72.7%, respectively. T-SPOT.TB was significantly different from the other two methods (P < 0.01). There was no significant difference in the sensitivity of T-SPOT.TB between the patients with severe tuberculosis and those with non-severe tuberculosis (P 0.05. 05). The median of T-SPOT.TB positive results of T-SPOT.TB positive spots in active TB patients and latent TB patients was 21 and 14, respectively. There was no significant difference between the two groups. The median number of antigenic B hole spots was 25 and 3, respectively (P < 0.05). Conclusion T-SPOT.TB is a better method for the diagnosis of tuberculosis. The negative results were of high diagnostic value in excluding active tuberculosis, and the positive results were of limited value in judging whether tuberculosis was active or not.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R52
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本文編號：1576536