本文選題：活動性結(jié)核病 + 酶聯(lián)免疫斑點技術(shù)�。� 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：背景：我國是結(jié)核病高發(fā)國家,結(jié)核病一直是最危及人類健康的傳染病之一,傳統(tǒng)的結(jié)核感染診斷技術(shù)如痰找抗酸桿菌和TST試驗,存在敏感性低及特異性較差的缺點。近年來一種以結(jié)核抗原特異性T細(xì)胞反應(yīng)為基礎(chǔ)的新的結(jié)核病診斷方法,即T-SPOT.TB,已在臨床逐步建立與開展起來。但該檢測方法的臨床應(yīng)用價值尚缺乏大樣本研究。 方法及目的：對2012年1月至2012年6月在浙江大學(xué)附屬第一醫(yī)院呼吸內(nèi)科和感染科收治的273例疑診為活動性結(jié)核感染的住院患者進(jìn)行回顧性分析。這273例患者均進(jìn)行外周血T-SPOT.TB檢測,將T-SPOT.TB檢測結(jié)果與最終臨床診斷進(jìn)行比較,以敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比、陰性似然比為評價指標(biāo),探討T-SPOT. TB在活動性結(jié)核病診斷中的應(yīng)用價值。同時比較T-SPOT.TB、痰找抗酸桿菌和TST試驗這三種檢測方法敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值之間的差異。評價T-SPOT.TB、痰找抗酸桿菌和TST試驗這三種方法在結(jié)核病診斷中不同的應(yīng)用價值。 結(jié)果：273例患者最終116例確診活動性結(jié)核病,144例患者排除結(jié)核,13例患者仍診斷不明。確診為活動性結(jié)核病的患者中101例T-SPOT.TB結(jié)果陽性,敏感性為87.07%。在144例排除活動性結(jié)核病診斷的患者中,115例患者T-SPOT.TB檢測結(jié)果為陰性,特異性為79.86%。陽性預(yù)測值為77.69%,陰性預(yù)測值88.46%,陽性似然比4.32,陰性似然比0.16。確診為活動性結(jié)核病的患者中,91例為肺結(jié)核患者,78例T-SPOT.TB檢測陽性,敏感性85.71%；25例肺外結(jié)核,23例T-SPOT.TB檢測陽性,敏感性為92%。T-SPOT.TB診斷肺外結(jié)核的敏感性明顯高于肺結(jié)核,差異有統(tǒng)計學(xué)意義(P0.01) 痰找抗酸桿菌敏感性32.97%,特異性99.04%,陽性預(yù)測值96.77%,陰性預(yù)測值62.80%。結(jié)核菌素試驗(TST)敏感性55.17%,特異性72.22%,陽性預(yù)測值61.54%,陰性預(yù)測值66.67%。三種方法中,T-SPOT.TB的敏感性和陰性預(yù)測值最高。T-SPOT.TB和痰找抗酸桿菌、TST試驗的敏感性和陰性預(yù)測值比較差異均有統(tǒng)計學(xué)意義,P0.01。痰找抗酸桿菌特異性和陽性預(yù)測值最高,三者比較差異有統(tǒng)計學(xué)意義,P0.05。 結(jié)論：本研究顯示T-SPOT. TB檢測有較高的敏感性,對臨床診斷提供有利的證據(jù)。較高的T-SPOT. TB陰性預(yù)測值提示陰性結(jié)果有助于排除活動性結(jié)核病的診斷。尤其在肺外結(jié)核診斷中敏感性高,解決了肺外結(jié)核診斷難這一難題。但T-SPOT.TB檢測存在一定的假陽性,而且費用高,限制了在欠發(fā)達(dá)地區(qū)的推廣
[Abstract]:Background: China is a country with high incidence of tuberculosis. Tuberculosis has been one of the most dangerous infectious diseases to human health. The traditional diagnostic techniques of tuberculosis infection such as acid-fast bacillus sputum and TST test have the disadvantages of low sensitivity and poor specificity. In recent years, a new diagnosis method of tuberculosis based on TB antigen-specific T cell reaction, T-SPOT.TB, has been gradually established and developed in clinical practice. However, the clinical application value of this method is still lack of large sample research. Methods and objective: from January 2012 to June 2012, 273 cases of suspected active tuberculosis infection were analyzed retrospectively in Department of Respiratory Medicine and Department of infection, the first affiliated Hospital of Zhejiang University. The results of T-SPOT.TB were compared with the final clinical diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used to evaluate T-SPOT. The value of TB in the diagnosis of active tuberculosis. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of T-SPOT.TB, acid-fast bacillus sputum and TST test were compared. To evaluate the value of T-SPOT.TB, acid-fast bacillus sputum and TST test in the diagnosis of tuberculosis. Results one hundred and seventy-three patients with active tuberculosis were diagnosed in the end. 144 cases were excluded from tuberculosis and 13 cases were still unknown. The T-SPOT.TB results were positive in 101 patients with active tuberculosis, and the sensitivity was 87.07. Of the 144 patients excluded from the diagnosis of active tuberculosis, T-SPOT.TB was negative in 115 patients and the specificity was 79.86. The positive predictive value was 77.69, the negative predictive value was 88.46, the positive likelihood ratio was 4.32, and the negative likelihood ratio was 0.16. Among the patients diagnosed as active tuberculosis, 91 were positive for T-SPOT.TB in pulmonary tuberculosis, and 23 were positive for T-SPOT.TB in 25 patients with extrapulmonary tuberculosis. The sensitivity of 92%.T-SPOT.TB in the diagnosis of extrapulmonary tuberculosis was significantly higher than that of pulmonary tuberculosis. The difference was statistically significant (P0.01). The sensitivity of sputum to acid-fast bacilli was 32.97, the specificity was 99.04, the positive predictive value was 96.77 and the negative predictive value was 62.80. The sensitivity of tuberculin test was 55.17, the specificity was 72.22, the positive predictive value was 61.54, and the negative predictive value was 66.67. The sensitivity and negative predictive value of T-SPOT.TB were the highest. T-SPOT.TB and TST test of acid-fast sputum had significant differences in sensitivity and negative predictive value (P 0.01). The specificity and positive predictive value of acid-fast bacillus in phlegm were the highest, and the difference was statistically significant (P 0.05). Conclusion: this study shows that T-SPOT. TB detection has high sensitivity and provides favorable evidence for clinical diagnosis. Higher T-SPOT. The negative predictive value of TB suggested that the negative results were helpful to exclude the diagnosis of active tuberculosis. Especially in the diagnosis of extrapulmonary tuberculosis high sensitivity, solve the problem of diagnosis of extrapulmonary tuberculosis difficult. However, there are some false positives in T-SPOT.TB test, and the cost is high, which limits the popularization in less developed areas.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R52

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王瑩;陽幼榮;尹文東;吳雪瓊;于庭;;全血γ-干擾素釋放試驗對活動性結(jié)核病的輔助診斷價值[J];標(biāo)記免疫分析與臨床;2012年04期

2 覃偉;銀春蓮;楊莉;李海;鄭春燕;;酶聯(lián)免疫斑點試驗對活動性結(jié)核病的診斷價值[J];廣西醫(yī)學(xué);2012年11期

3 張熙穆;;患活動性結(jié)核病能妊娠嗎?[J];父母必讀;1998年09期

4 丁國林;胡瑞芬;;老年人活動性結(jié)核病的藥物治療及其不良反應(yīng)[J];國外醫(yī)學(xué)(老年醫(yī)學(xué)分冊);1994年05期

5 姜凌云，彭衛(wèi)生，，謝曉敏,韓梅，裴秀英，王倩;活動性結(jié)核病患者血淋巴細(xì)胞DNA修復(fù)功能的研究[J];北京醫(yī)學(xué);1997年02期

6 王瑩;吳雪瓊;于庭;;活動性結(jié)核病患者全血干擾素誘導(dǎo)蛋白10測定及免疫狀態(tài)的研究[J];中國實驗診斷學(xué);2012年02期

7 盧峰岳;黃艷君;劉春平;蔡杏珊;譚耀駒;;γ-干擾素釋放試驗診斷活動性結(jié)核病的臨床評價[J];實用醫(yī)學(xué)雜志;2013年23期

8 趙淑燕;;血液病合并活動性結(jié)核病24例診斷與護(hù)理[J];齊魯護(hù)理雜志;2011年22期

9 劉君炎,張紹金,蔣正明,樊興豪,郭堅;以聚合OT為抗原用酶聯(lián)免疫吸附試驗診斷活動性結(jié)核病的研究[J];中國免疫學(xué)雜志;1985年02期

10 肖彭年,莫榴琴,楊翼峰;結(jié)素蛋白多肽和微波技術(shù)在活動性結(jié)核病診斷中的意義[J];中國防癆雜志;2000年04期

相關(guān)會議論文 前7條

1 劉瑾;冀澍雨;孫銘;;結(jié)明試驗用于活動性結(jié)核病診斷的效果評價[A];加入WTO和中國科技與可持續(xù)發(fā)展——挑戰(zhàn)與機(jī)遇、責(zé)任和對策（下冊）[C];2002年

2 孫銘;梁月;;結(jié)明試驗用于活動性結(jié)核病診斷的效果評價[A];中國防癆協(xié)會全國學(xué)術(shù)會議大會學(xué)術(shù)報告[C];2001年

3 劉菲;張宗德;陳曦;杜鳳嬌;楊新婷;劉洋;賈紅彥;古淑香;馬s

本文編號：1943812