本文選題：結核 + 細胞因子�。� 參考：《中南大學》2013年碩士論文

【摘要】：目的：評價結核感染T細胞斑點試驗(T-SPOT.TB)聯(lián)合血漿細胞因子INF-γ、IL-10等檢測對活動性結核病與非活動性結核病的鑒別診斷價值以及結核病中Th1型/Th2型細胞因子變化特點。 方法：前瞻性納入中南大學湘雅三醫(yī)院2012年10月至2013年2月疑診結核感染的住院或門診患者75例以及24例行健康體檢的醫(yī)務工作者,分別行外周血T-SPOT.TB檢測,采集血漿標本凍存以及收集完整的臨床資料。在研究終點(2013年5月)對所有納入對象進行診斷評估,將最終符合入組標準的研究對象,分為三組即活動性結核組(設為A組),非活動性結核組(設為B組)和健康對照組(設為C組)。分別檢測三組血漿INF-γ、IL-2、IL-4、IL-10濃度,并比較兩組之間的濃度差異,以及比較A組與B組T-SPOT.TB結果陽性者各孔斑點數(shù)大小,均以P0.05為差異有統(tǒng)計學意義。如果某細胞因子或某斑點數(shù)在A組與B組之間有顯著差異,則通過ROC曲線分析,判斷其診斷價值大小,當約登指數(shù)最大時,此時該細胞因子濃度或斑點數(shù)目為鑒別兩者的最佳臨界值,并算出其診斷靈敏度,特異度以及陽性似然比、陰性似然比。 結果：根據診斷與入組標準,最終納入研究對象72例,分別是A組32例,B組(包括陳舊性結核16例,結核潛伏感染者4例)20例,C組20例。血漿INF-γ、IL-2、IL-4、IL-10在A組中濃度分別是115.94±14.01,452.95±209.90,260.70±95.73,152.86±37.11,在B組中濃度分別是89.79±4.25,499.78±197.15,260.46±134.33,86.68±15.71,在C組中濃度分別是90.79±3.88,510.10±103.03,204.98±108.81,64.51±9.66。A組與B組相比,INF-γ及IL-10在兩組之間均有顯著差異,P0.05；IL-2及IL-4在兩組之間均無顯著差異,P0.05。B組與C組相比,INF-γ及IL-2在兩組之間均無顯著差異,P0.05；IL-4及IL-10在兩組之間均有顯著差異,P0.05。A組與B組T-SPOT.TB結果陽性者A孔、B孔及A+B孔斑點數(shù)中位數(shù)分別是,23與19,74.5與25,115.5與49,A孔及A+B孔斑點數(shù)之和在兩組之間均無顯著差異,P0.05；B孔斑點數(shù)在兩組之間有顯著差異,P0.05。在A組與B組之間,通過對兩組B孔斑點數(shù)、血漿INF-γ及IL-10濃度做ROC曲線分析,得出AUC分別是0.69,0.95,0.98,以B孔斑點數(shù)74.5個,INF-γ濃度94.38pg/ml,IL-10濃度109.82pg/m1分別為臨界值,鑒別活動性結核與非活動性結核靈敏度、特異度、陽性似然比、陰性似然比分別是：50.0%,93.8%,93.8%；89.5%,85.0%,90.0%；4.76,6.25,9.38；0.56,0.07,0.07。 結論：1.Th1型/Th2型細胞因子的動態(tài)失衡在結核發(fā)生發(fā)展中起重要作用,可能當Th2型細胞因子占主導地位時促進了結核的發(fā)生發(fā)展。 2.T-SPOT.TB聯(lián)合血漿INF-γ、IL-10濃度檢測可對結核作出精確診斷,有較高的診斷價值。疑診結核感染患者可先行T-SPOT.TB檢測,當結果陽性時,再測定血漿INF-γ或IL-10的濃度,有助于區(qū)分活動性結核與非活動性結核,其中IL-10的陽性似然比更高,更有助于活動性結核病的診斷。 3.活動性結核患者與非活動性結核患者,當T-SPOT.TB結果陽性時,僅B孔斑點數(shù)在兩者之間有顯著差異,但尚不足以憑借B孔斑點數(shù)較好區(qū)分活動性結核與非活動性結核。圖12幅,表3個,參考文獻46篇。
[Abstract]:Objective : To evaluate the value of T - SPOT . TB combined with plasma cytokines INF - 緯 and IL - 10 in the differential diagnosis of active tuberculosis and non - active tuberculosis and the changes of Th1 / Th2 cytokines in tuberculosis .

Methods : Seventy - five patients with tuberculosis infection , 75 patients with tuberculosis infection , 75 patients with active tuberculosis ( Group A ) , non - active tuberculosis group ( group B ) and healthy control group ( group C ) were prospectively enrolled .

Results : In group A , the concentrations of INF - 緯 , IL - 2 , IL - 4 , IL - 10 in group A were 89.79 鹵 14.01 , 452.95 鹵 209.90 , 268.70 鹵 95.73 , 152.86 鹵 37.11 respectively . The concentrations of INF - 緯 , IL - 2 , IL - 4 and IL - 10 in group A were 89.79 鹵 4.25 , 499.78 鹵 103.03 , 202.46 鹵 103.73 , 86.68 鹵 15.71 , respectively , and the concentrations of INF - 緯 and IL - 10 in group B were significantly different than those in group B , P < 0.05 ;
There was no significant difference between the two groups of IL - 2 and IL - 4 , but there was no significant difference between the two groups ( P0.05 ) .
There was a significant difference between the two groups of IL - 4 and IL - 10 . The median number of spots in group A , B and A + B in group A and group B were 23 and 19 , 74 . 5 and 25 , 115 . 5 and 49 respectively , and there was no significant difference between the two groups , P 0 . 05 ;
In group A and group B , the number of B - hole spots , plasma INF - 緯 and IL - 10 concentration were analyzed by ROC curve . The results showed that the AUC were 0.69 , 0.95 and 0.98 respectively , and the sensitivity , specificity , positive likelihood ratio and negative likelihood ratio of active tuberculosis and non - active tuberculosis were 50.0 % , 93.8 % and 93.8 % respectively .
89.5 % , 85.0 % , 90.0 % ;
4.76 , 6.25 , 9.38 ;
0.56 , 0.07 , 0.07 .

Conclusion : 1 . The dynamic imbalance of Th1 / Th2 cytokines plays an important role in the development of tuberculosis , which may promote the development of tuberculosis when Th2 cytokines predominate .

2 . T - SPOT . TB combined with plasma INF - 緯 and IL - 10 concentrations can be used for accurate diagnosis of tuberculosis . It has high diagnostic value . When the results are positive , the concentration of INF - 緯 or IL - 10 can be measured , which helps to distinguish active tuberculosis and non - active tuberculosis . The positive likelihood ratio of IL - 10 is higher , which is helpful for the diagnosis of active tuberculosis .

3 . When T - SPOT . TB results were positive in patients with active tuberculosis , only the number of B - hole spots was significantly different between them , but it was not enough to distinguish active tuberculosis from non - active tuberculosis with B - hole spots . Fig . 12 , Table 3 , Reference 46 .

【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R52

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