本文選題：結(jié)核 + 細(xì)胞因子　； 參考：《中南大學(xué)》2013年碩士論文

【摘要】：目的：評(píng)價(jià)結(jié)核感染T細(xì)胞斑點(diǎn)試驗(yàn)(T-SPOT.TB)聯(lián)合血漿細(xì)胞因子INF-γ、IL-10等檢測(cè)對(duì)活動(dòng)性結(jié)核病與非活動(dòng)性結(jié)核病的鑒別診斷價(jià)值以及結(jié)核病中Th1型/Th2型細(xì)胞因子變化特點(diǎn)。 方法：前瞻性納入中南大學(xué)湘雅三醫(yī)院2012年10月至2013年2月疑診結(jié)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(wù)工作者,分別行外周血T-SPOT.TB檢測(cè),采集血漿標(biāo)本凍存以及收集完整的臨床資料。在研究終點(diǎn)(2013年5月)對(duì)所有納入對(duì)象進(jìn)行診斷評(píng)估,將最終符合入組標(biāo)準(zhǔn)的研究對(duì)象,分為三組即活動(dòng)性結(jié)核組(設(shè)為A組),非活動(dòng)性結(jié)核組(設(shè)為B組)和健康對(duì)照組(設(shè)為C組)。分別檢測(cè)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(jié)果陽(yáng)性者各孔斑點(diǎn)數(shù)大小,均以P0.05為差異有統(tǒng)計(jì)學(xué)意義。如果某細(xì)胞因子或某斑點(diǎn)數(shù)在A組與B組之間有顯著差異,則通過(guò)ROC曲線分析,判斷其診斷價(jià)值大小,當(dāng)約登指數(shù)最大時(shí),此時(shí)該細(xì)胞因子濃度或斑點(diǎn)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(yáng)性似然比、陰性似然比。 結(jié)果：根據(jù)診斷與入組標(biāo)準(zhǔn),最終納入研究對(duì)象72例,分別是A組32例,B組(包括陳舊性結(jié)核16例,結(jié)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(wú)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(wú)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(jié)果陽(yáng)性者A孔、B孔及A+B孔斑點(diǎn)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(diǎn)數(shù)之和在兩組之間均無(wú)顯著差異,P0.05；B孔斑點(diǎn)數(shù)在兩組之間有顯著差異,P0.05。在A組與B組之間,通過(guò)對(duì)兩組B孔斑點(diǎn)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(diǎn)數(shù)74.5個(gè),INF-γ濃度94.38pg/ml,IL-10濃度109.82pg/m1分別為臨界值,鑒別活動(dòng)性結(jié)核與非活動(dòng)性結(jié)核靈敏度、特異度、陽(yáng)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(jié)論：1.Th1型/Th2型細(xì)胞因子的動(dòng)態(tài)失衡在結(jié)核發(fā)生發(fā)展中起重要作用,可能當(dāng)Th2型細(xì)胞因子占主導(dǎo)地位時(shí)促進(jìn)了結(jié)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(cè)可對(duì)結(jié)核作出精確診斷,有較高的診斷價(jià)值。疑診結(jié)核感染患者可先行T-SPOT.TB檢測(cè),當(dāng)結(jié)果陽(yáng)性時(shí),再測(cè)定血漿INF-γ或IL-10的濃度,有助于區(qū)分活動(dòng)性結(jié)核與非活動(dòng)性結(jié)核,其中IL-10的陽(yáng)性似然比更高,更有助于活動(dòng)性結(jié)核病的診斷。 3.活動(dòng)性結(jié)核患者與非活動(dòng)性結(jié)核患者,當(dāng)T-SPOT.TB結(jié)果陽(yáng)性時(shí),僅B孔斑點(diǎn)數(shù)在兩者之間有顯著差異,但尚不足以憑借B孔斑點(diǎn)數(shù)較好區(qū)分活動(dòng)性結(jié)核與非活動(dòng)性結(jié)核。圖12幅,表3個(gè),參考文獻(xiàn)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(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R52

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