本文選題：PPD試驗(yàn) + 結(jié)明三項(xiàng)��； 參考：《鄭州大學(xué)》2012年碩士論文

【摘要】：目的 探討結(jié)核菌素純蛋白衍生物皮膚試驗(yàn)(PPD試驗(yàn))、結(jié)明三項(xiàng)(TB-CHECK試驗(yàn)、TB-DOT試驗(yàn)、TB-Ab試驗(yàn))聯(lián)合6kD早期分泌抗原誘導(dǎo)的γ干擾素釋放反應(yīng)(ESAT-6檢測(cè))在菌陰肺結(jié)核診斷中的價(jià)值。 對(duì)象與方法 搜集河南省胸科醫(yī)院呼吸內(nèi)科和結(jié)核科在2011年1月至2012年2月期間收治的資料比較完整的病例328例,其中初治菌陰肺結(jié)核106例,初治菌陽(yáng)肺結(jié)核89例,肺部其他疾病133例。 初治菌陰肺結(jié)核組：共106例,其中男65例,女41例,年齡4-79歲,平均年齡為34.07-17.69歲,患者有典型的臨床表現(xiàn)及胸部X線(或胸部CT)存在活動(dòng)性肺結(jié)核征象,已排除其他非結(jié)核性的肺部疾病,均符合中華醫(yī)學(xué)會(huì)結(jié)核病學(xué)分會(huì)于2001年制定的《肺結(jié)核診斷與治療指南》中活動(dòng)性菌陰肺結(jié)核的相關(guān)診斷標(biāo)準(zhǔn)。此組沒(méi)有應(yīng)用抗結(jié)核藥物治療或者治療時(shí)間不超過(guò)一個(gè)月,以減少抗結(jié)核治療對(duì)檢查結(jié)果的影響。此組主要用來(lái)評(píng)估各項(xiàng)指標(biāo)聯(lián)合檢測(cè)的診斷價(jià)值。 初治菌陽(yáng)肺結(jié)核組：共89例,其中男51例,女38例,年齡14-88歲,平均年齡為41.13±21.06歲,其診斷均符合國(guó)際傳染性肺結(jié)核診斷標(biāo)準(zhǔn)。此組主要用來(lái)評(píng)估各項(xiàng)檢測(cè)指標(biāo)的敏感性。 肺部其他疾病組：共133例,其中男84例,女49例,年齡4-87歲,平均年齡為57.72±18.30歲。其中小細(xì)胞肺癌10例,肺腺癌36例,肺鱗癌20例,大細(xì)胞肺癌2例,神經(jīng)鞘瘤1例,慢性阻塞性肺疾20例,肺炎9例,支氣管擴(kuò)張19例,肺膿腫5例,慢性支氣管8炎,其他3例。均經(jīng)相關(guān)檢查確診并排除合并有肺結(jié)核的存在,此組用于評(píng)價(jià)各項(xiàng)檢測(cè)方法的特異性。 統(tǒng)計(jì)學(xué)方法 應(yīng)用SPSS13.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)數(shù)資料組間顯著性檢驗(yàn)比較采用χ2檢驗(yàn),設(shè)定標(biāo)準(zhǔn)a=0.05,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.PPD試驗(yàn)、結(jié)明三項(xiàng)、ESAT-6檢測(cè)中的各項(xiàng)指標(biāo)在菌陰肺結(jié)核組的陽(yáng)性率均高于肺部非結(jié)核疾病組,各項(xiàng)檢測(cè)指標(biāo)在兩組間的比較有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.PPD試驗(yàn)、結(jié)明三項(xiàng)、ESAT-6檢測(cè)中的各項(xiàng)檢測(cè)指標(biāo)中以ESAT-6檢測(cè)的診斷指數(shù)157.22%最高,診斷效能最好。其敏感性及特異性分別為79.78%、77.44%。 3.隨著聯(lián)合指標(biāo)的增多,菌陰肺結(jié)核的陽(yáng)性檢出率逐漸增高。有ESAT-6檢測(cè)參與的2聯(lián)、3聯(lián)的陽(yáng)性率均高于無(wú)ESAT-6檢測(cè)參與組,其差異有統(tǒng)計(jì)學(xué)意義(P0.05),而4聯(lián)的陽(yáng)性率相近,其差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 4.在各項(xiàng)指標(biāo)的聯(lián)合檢測(cè)中,以ESAT-6+PPD+TB-Ab的診斷指數(shù)152.05%最高,診斷效能最好,其敏感性和特異性分別為93.40%、58.65%。 結(jié)論 多項(xiàng)檢測(cè)指標(biāo)聯(lián)合檢測(cè)較單項(xiàng)檢測(cè)可以提高菌陰肺結(jié)核診斷的敏感性。ESAT-6+PPD+TB-Ab三項(xiàng)指標(biāo)聯(lián)合檢測(cè)為最佳組合。
[Abstract]:Purpose To investigate the diagnostic value of PPD test and TB-DOT test combined with interferon 緯 release response induced by early secretion antigen of 6kD (PPD test and TB-DOT test combined with ESAT-6 test) in the diagnosis of pulmonary tuberculosis of bacterioculmonary vulva (PPD test) and TB-DOT test (TB-DOT test) combined with interferon 緯 release response induced by early secreting antigen of 6kD. Objects and methods From January 2011 to February 2012, 328 cases with complete data were collected from Department of Respiratory Medicine and Department of Tuberculosis, Henan chest Hospital. Among them, 106 cases were first treated with bacilli negative tuberculosis, 89 cases were initially treated with bacillus positive tuberculosis and 133 cases with other pulmonary diseases. There were 106 cases of pulmonary tuberculosis of bacterial negative, including 65 males and 41 females, aged 4-79 years, with an average age of 34.07-17.69 years. The patients had typical clinical manifestations and active pulmonary tuberculosis signs on chest X-ray (or chest CTS). Other non-tuberculous pulmonary diseases have been excluded, which are in line with the diagnostic criteria of active bacilli negative tuberculosis in the guidelines for the diagnosis and treatment of Pulmonary Tuberculosis, formulated by the Chinese Medical Association Tuberculosis Society in 2001. This group was not treated with antituberculous drugs or for less than a month to reduce the impact of antituberculotic therapy on the results of the examination. This group is mainly used to evaluate the diagnostic value of combined detection of various indicators. A total of 89 cases (51 males and 38 females, aged 14-88 years, with an average age of 41.13 鹵21.06 years) were treated with bacillus positive pulmonary tuberculosis. All of them were in accordance with the international diagnostic criteria for infectious pulmonary tuberculosis. This group is mainly used to evaluate the sensitivity of the various indicators. There were 133 patients with other pulmonary diseases, including 84 males and 49 females, aged 4-87 years, with an average age of 57.72 鹵18.30 years. There were 10 cases of small cell lung cancer, 36 cases of lung adenocarcinoma, 20 cases of lung squamous cell carcinoma, 2 cases of large cell lung cancer, 1 case of neurilemmoma, 20 cases of chronic obstructive pulmonary disease, 9 cases of pneumonia, 19 cases of bronchiectasis, 5 cases of pulmonary abscess and 8 cases of chronic bronchitis. Other 3 cases. All the patients were diagnosed by correlation examination and the presence of pulmonary tuberculosis was excluded. This group was used to evaluate the specificity of each detection method. Statistical method The statistical software of SPSS13.0 was used to analyze the data. 蠂 2 test was used to compare the significant test among the counting data groups, and the difference was statistically significant in setting the standard a0.05% (P0.05). Result In 1.PPD test, the positive rate of ESAT-6 was significantly higher in pulmonary tuberculosis group than in pulmonary non-tuberculosis group, and there was significant difference between the two groups. In the 2.PPD test, the diagnostic index of ESAT-6 was the highest among the three items of ESAT-6, and the diagnostic efficiency was the best. The sensitivity and specificity were 79.78 and 77.44 respectively. 3. With the increase of combined indexes, the positive detection rate of bacilli-negative pulmonary tuberculosis increased gradually. The positive rate of two and three pairs of ESAT-6 was higher than that of the group without ESAT-6 detection, the difference was statistically significant (P 0.05), but the positive rate of the four groups was similar, the difference was not statistically significant (P 0.05). 4. The diagnostic index of ESAT-6 PPD TB-Ab was 152.05%, and the diagnostic efficiency was the best. The sensitivity and specificity were 93.404.65% and 58.65%, respectively. Conclusion The combined detection of multiple detection indexes can improve the sensitivity of the diagnosis of negative pulmonary tuberculosis. ESAT-6 PPD TB-Ab combined detection is the best combination.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R521

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