【摘要】：[目的]探討結(jié)核感染T細(xì)胞斑點(diǎn)試驗(T-SPOT.TB)對不同BMI組疑似肺結(jié)核患者的診斷價值,分析BMI與血常規(guī)淋巴細(xì)胞計數(shù)、血常規(guī)單核細(xì)胞數(shù)及血結(jié)核感染T細(xì)胞斑點(diǎn)試驗中致敏的結(jié)核桿菌特異性T淋巴細(xì)胞數(shù)(即斑點(diǎn)數(shù))是否有相關(guān)性。[方法]1.回顧性分析2015年1月1日至2016年12月31日昆明醫(yī)科大學(xué)第一附屬醫(yī)院呼吸內(nèi)科收治并行T-SPOT.TB檢測的疑似肺結(jié)核病例共240例。經(jīng)完善痰和支氣管肺泡液抗酸桿菌涂片及和結(jié)核分枝桿菌培養(yǎng)、組織病理學(xué)檢查等,最終診斷為肺結(jié)核患者138例,非肺結(jié)核患者102例。按照BMI指數(shù)分為A組(即消瘦組BMI18.6kg/m2)、B 組(即正常組 18.6≤BMI≤22.9kg/mm2)、C 組(即超重和肥胖組BMI≥23kg/m2)。2.記錄入選患者出院診斷、年齡、性別、身高、體重、體重指數(shù),并記錄結(jié)核感染T細(xì)胞檢測結(jié)果、入院后第一次血常規(guī)的淋巴細(xì)胞計數(shù)和單核細(xì)胞數(shù),將T-SPOT.TB結(jié)果與診斷結(jié)果進(jìn)行比較,分析T-SPOT.TB的診斷效能。性別計數(shù)資料用卡方檢驗,其它計數(shù)資料采用率及構(gòu)成比表示,組間比較采用Youden指數(shù)和診斷準(zhǔn)確率,P0.05表示有統(tǒng)計學(xué)意義。基本描述計量資料為正態(tài)分布或者近似正態(tài)分布,采用均數(shù)±標(biāo)準(zhǔn)差表示,組內(nèi)比較采用配對t檢驗,各組間兩兩對比采用方差分析中多個樣本均數(shù)的兩兩比較q檢驗。[結(jié)果]本研究共納入研究對象240例,男性153名,女性87名,性別比例為1.76,年齡最小為18歲,最大為87歲,平均年齡為49.41 ±18.81歲。其中A組45人,B組162人,C組33人。三組間年齡性別差異無統(tǒng)計學(xué)意義。T-SPOT.TB試驗對B組的敏感性及特異性均較高,而對A組和C組敏感性及特異性均較差。血常規(guī)T淋巴細(xì)胞數(shù)分析B組C組A組,組間比較僅A組和B組差異有統(tǒng)計學(xué)意義。血常規(guī)單核細(xì)胞數(shù)分析B組C組A組,A組和B組差異有統(tǒng)計學(xué)意義,A組和C組差異有統(tǒng)計學(xué)意義,C組和B組差異無統(tǒng)計學(xué)意義。三組患者致敏性T淋巴細(xì)胞數(shù)組內(nèi)比較A孔斑點(diǎn)數(shù)和B孔斑點(diǎn)數(shù)無統(tǒng)計學(xué)差異,三組中A孔斑點(diǎn)數(shù)有統(tǒng)計學(xué)差異,B組大于A組和C組。三組中B孔斑點(diǎn)數(shù)差異有統(tǒng)計學(xué)意義,B組大于A組和C組。[結(jié)論]1.消瘦、超重及肥胖均能降低T-SPOT.TB試驗敏感性、特異性、陽性預(yù)測值及陰性預(yù)測值,從而導(dǎo)致T-SPOT.TB試驗對肺結(jié)核的診斷準(zhǔn)確率下降;2.消瘦、超重及肥胖患者,機(jī)體免疫功能紊亂,導(dǎo)致結(jié)核感染后致敏性T淋巴細(xì)胞減少,γ-干擾素釋放減少,T-SPOT.TB結(jié)果A孔和B孔斑點(diǎn)數(shù)減少;3.消瘦患者T淋巴細(xì)胞下調(diào)更明顯,導(dǎo)致T-SPOT.TB試驗對肺結(jié)核診斷價值下降;4.單核細(xì)胞高的患者,T-SPOT.TB結(jié)果A孔和B孔斑點(diǎn)數(shù)也較高。
[Abstract]:[objective] to investigate the diagnostic value of T-SPOT.TB in suspected pulmonary tuberculosis patients with different BMI, and to analyze BMI and routine lymphocyte count. Whether there is a correlation between the number of monocytes in blood routine and the number of specific T lymphocytes (I. E. spot number) sensitized to Mycobacterium tuberculosis in blood tuberculosis infection T cell spot test. [methods] 1. From January 1, 2015 to December 31, 2016, 240 suspected pulmonary tuberculosis cases treated in Department of Respiratory, the first affiliated Hospital of Kunming Medical University were analyzed retrospectively. 138 cases of pulmonary tuberculosis and 102 cases of non-pulmonary tuberculosis were diagnosed by improving sputum and bronchoalveolar fluid acid-fast bacilli smear and culture of Mycobacterium tuberculosis and histopathological examination. According to BMI index, they were divided into two groups: group A (BMI18.6 kg / m2) and group B (18.6 鈮，

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