本文選題：結(jié)核性胸膜炎診斷 + T-SPOT��； 參考：《吉林大學(xué)》2013年碩士論文

【摘要】：結(jié)核性胸膜炎是最常見的肺外結(jié)核病，也是胸腔積液最常見的原因。由于該病在臨床上缺乏特異性表現(xiàn)，用胸液細菌學(xué)方法檢測陽性率低，胸膜活檢的創(chuàng)傷性限制了其在臨床的推廣應(yīng)用，分子生物學(xué)雖然提供了快速診斷技術(shù)，但是仍然存在假陽性及技術(shù)等方面的問題，給結(jié)核性胸膜炎的早期診斷帶來一定難度，T-SPOT TB是近年來興起的檢測細胞免疫功能的一種方法，此方法靈敏度高，特異性好，逐漸成為結(jié)核診斷研究的熱點。本研究通過對93例住院的胸腔積液患者進行外周血T-SPOT TB檢測，探討T-SPOT TB在結(jié)核性胸膜炎中的臨床應(yīng)用價值。 目的：通過對胸腔積液患者外周血進行T-SPOT TB檢測，并與胸腔積液中腺苷脫氨酶(ADA)檢測、血清結(jié)核抗體檢測、胸水結(jié)核菌培養(yǎng)比較，探討T-SPOT TB（結(jié)核感染T細胞斑點試驗）在結(jié)核性胸膜炎診斷及鑒別診斷中的臨床應(yīng)用價值。 方法：受試者共93例，結(jié)核性胸膜炎患者48例，惡性胸腔積液45例。用T-SPOT TB檢測上述受試者的外周血單個核細胞（PBMC）中對結(jié)核分枝桿菌早期分泌靶向抗原6（Early secretory antigen target-6,ESAT-6）和/或培養(yǎng)濾液蛋白10（Culture filtrate protein-10,CFP-10）致敏的T淋巴細胞即斑點形成細胞（Spot forming cell，SFC）的數(shù)量，并與其他相關(guān)指標(biāo)：胸腔積液中腺苷脫氨酶(ADA)、血清結(jié)核抗體檢測、胸水結(jié)核菌培養(yǎng)進行比較。 結(jié)果： 1、T-SPOT TB檢測在結(jié)核性胸膜炎組陽性率為91.67%，顯著高于惡性胸腔積液的陽性率：8.89%，差異具有統(tǒng)計學(xué)意義（P0.05） 2、聯(lián)合應(yīng)用早期分泌靶向抗原6（ESAT-6）和培養(yǎng)濾液蛋白10（CFP-10）的敏感性（91.67%）高于單用ESAT-6的敏感性（85.42%）或單用CFP-10的敏感性（75.00%），但聯(lián)用與單用任一抗原的敏感性差別無統(tǒng)計學(xué)意義。 3、T-SPOT TB、胸腔積液中腺苷脫氨酶(ADA)檢測、血清結(jié)核抗體檢測、胸水結(jié)核菌培養(yǎng)的敏感性分別為91.67%、70.83%、62.50%、14.58%，特異性分別為91.11%、55.56%、62.50%、100%，診斷準(zhǔn)確率分別為94.24%、63.44%、62.37%、55.91%，T-SPOT TB檢測的敏感性高于其他檢驗方法，，其差異具有統(tǒng)計學(xué)意義（P0.05）。 結(jié)論：T-SPOT TB可用于結(jié)核性胸膜炎的診斷和鑒別診斷。在診斷結(jié)核性胸膜炎時T-SPOT TB擁有較高的敏感性、特異性、和診斷準(zhǔn)確率，T-SPOT TB對結(jié)核性胸膜炎的早期診斷具有較高的應(yīng)用價值，值得在臨床廣泛推廣和應(yīng)用。
[Abstract]:Tuberculous pleurisy is the most common extrapulmonary tuberculosis and the most common cause of pleural effusion. Due to the lack of specific clinical manifestations, the positive rate of pleural fluid bacteriology is low, and the traumatic pleural biopsy limits its clinical application. Molecular biology provides a rapid diagnostic technique. However, there are still some problems in false positives and techniques, which make it difficult for the early diagnosis of tuberculous pleurisy. T-spot TB is a new method to detect cellular immune function in recent years. This method has high sensitivity and good specificity. It has gradually become a hot spot in tuberculosis diagnosis. In this study, the clinical value of T-spot TB in tuberculous pleurisy was studied by detecting T-spot TB in 93 patients with pleural effusion. Objective: to detect T-spot TB in peripheral blood of patients with pleural effusion and compare it with adenosine deaminase (ADA) in pleural effusion, serum tuberculosis antibody and culture of tuberculous bacteria in pleural effusion. To evaluate the clinical value of T-spot TB (T-spot TB) in the diagnosis and differential diagnosis of tuberculous pleurisy. Methods: there were 93 cases of tuberculous pleurisy, 48 cases of tuberculous pleurisy and 45 cases of malignant pleural effusion. T-spot TB was used to detect the number of T lymphocytes sensitized with early secretory antigen target-6 ESAT-6 and / or culture filtrate protein-10 CFP-10 in peripheral blood mononuclear cells (PBMCs) of these subjects. And compared with other related indexes: adenosine deaminase (ADA) in pleural effusion, detection of serum tuberculosis antibody and culture of tuberculous bacteria in pleural effusion. Results: 1 the positive rate of T-spot TB in tuberculous pleurisy was 91.67, which was significantly higher than that in malignant pleural effusion (P 0.05). The sensitivity of culture filtrate protein 10 (CFP-10) (91.67%) was higher than that of ESAT-6 alone (85.42%) or CFP-10 alone (75.00%). The sensitivity of tuberculous bacillus culture in serum was 91.67 and 70.83 and the sensitivity was 62.50 and 14.58, and the specificity was 91.115.56 and 62.500.100, respectively. The diagnostic accuracy was 94.240.63.440.62.37 and the sensitivity of T-SPOT TB was higher than that of other test methods, and the difference was statistically significant (P0.05). Conclusion: t-spot TB can be used in the diagnosis and differential diagnosis of tuberculous pleurisy. T-spot TB has high sensitivity, specificity and diagnostic accuracy in the diagnosis of tuberculous pleurisy. T-spot TB has a high value in early diagnosis of tuberculous pleurisy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R521.7

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