本文關(guān)鍵詞：T-SPOT.TB試驗在結(jié)核性胸腔積液診斷中的應(yīng)用價值，由筆耕文化傳播整理發(fā)布。

        目的探討T-SPOT.TB試驗在結(jié)核性胸腔積液診斷中的應(yīng)用價值方法分離69例胸腔積液患者的外周血單個核細胞(PBMCs)和胸腔積液單個核細胞(PEMCs)，經(jīng)早期分泌抗原靶6kD(ESAT-6)和培養(yǎng)濾液蛋白10kD(CFP-10)抗原共同孵育,進行酶聯(lián)免疫斑點試驗（ELISPOT試驗）,檢測經(jīng)抗原刺激后分泌γ干擾素的效應(yīng)T淋巴細胞,即斑點形成細胞(SFCs)的數(shù)量，以中位數(shù)、四分位間距表示，根據(jù)使用說明評價其敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比和陰性似然比，并根據(jù)受試者工作特征曲線(ROC曲線)建立合理的臨床判斷臨界值及其檢測的敏感性和特異性。結(jié)果69例病人中5例獲得不確定結(jié)果，64例獲得有效結(jié)果，最終34例診斷為結(jié)核性胸腔積液，30例診斷為非結(jié)核性胸腔積液。結(jié)核性胸腔積液組中，sESAT-6、pESAT-6、sCFP-10和pCFP-10抗原(s表示外周血，p表示胸水)形成的斑點形成細胞(SFCs)中位數(shù)和四分位數(shù)間距分別為22、15-27.5，94、48.75-231，20、14.25-26.25，114、47.25-245.5。30例非結(jié)核性胸腔積液組中，sESAT-6、pESAT-6、sCFP-10和pCFP-10抗原形成的斑點形成細胞(SFCs)中位數(shù)和四分位數(shù)間距分別為3、2-5，2、1-3，3、2-4和3、1.75-4。結(jié)核組2種抗原在外周血及胸水中的SFCs均高于非結(jié)核組（p＜0.05）。結(jié)核組2種抗原在胸水中的SFCs高于外周血的SFC（sp＜0.05）。非結(jié)核組胸水和外周血中2種抗原的SFCs無統(tǒng)計學(xué)差異（p＞0.05）。sESAT-6、sCFP-10、pESAT-6、pCFP-10、sT-SPOT.TB和pT-SPOT.TB診斷結(jié)核的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比和陰性似然比分別為：85.29%、90%、90.63%、84.38%、8.53、0.16；79.41%、93.33%、93.10%、80%、11.91、0.22；91.18%、83.33%、86.11%、89.29%、5.47、0.11；91.18%、83.33%、86.11%、89.29%、5.47、0.11；88.24%、86.67%、88.24%、86.7%、6.62、0.14；91.18%、83.33%、86.11%、89.29%、5.47、0.11。sESAT-6、sCFP-10、pESAT-6和pCFP-10抗原診斷結(jié)核性胸腔積液的ROC曲線下面積（AUC）、臨界值(cut-off point)、敏感性、特異性分別為：0.877、11、85.3%、90%，0.903、11、79.4%、93.3%，0.929、14.5、91.2%、83.3%和0.937、30、88.2%、90%。結(jié)論T-SPOT.TB能夠輔助診斷結(jié)核性胸腔積液，具有較高的敏感性和特異性。

    Objective To investigate the diagnostic value of T-SPOT.TB assay for tuberculosispleural effusion.Methods The peripheral blood mononuclear cells（PBMCs） and pleural effusionmononuclear cells (PEMCs) were separated from69patients. Then the early secretoryantigenic target6(ESAT-6) and culture filtered protein10were co-cultured.Then Tlymphocytes releasing interferon-γ were detected which record as spot formingcells(SFCs) with a median and interquartile range by ELISPOT assay. Sensitivity,specificity, positive predictive value, negative predictive value, positive likelihood ratio,negative likelihood ratio were also detected. The optimum cut-off points resultingfrom the best sensitivity-specificity balance in the ROC curves were constructed.Results Five of the69patients gave indeterminate ELISPOT assay results.34patientswere dignosised with tuberculosis pleural effusion, and30patients were dignosisedwith no-tuberculosis pleural effusion. The median and interquartile range of SFCs fromsESAT-6、pESAT-6、sCFP-10and pCFP-10（s represent blood，p represent plural）were22、15-27.5，94、48.75-231，20、14.25-26.25and114、47.25-245.5respectivelywith tuberculosis pleural effusion.The median and interquartile range of SFC fromsESAT-6、pESAT-6、sCFP-10and pCFP-10were3、2-5，，2、1-3，3、2-4，3and1.75-4respectively with no-tuberculosis pleural effusion. The number of ESAT-6and CFP-10specific cells in the pleural fluid or peripheral blood in TB group are both higher than the number in NTB group（p＜0.05）.The number of ESAT-6and CFP-10specific cellsin the pleural fluid are higher than the number in peripheral blood in TB group（p＜0.05）,which can not be found in NTB group（p＞0.05）.The sensitivity, specificity,positive predietive value,Negative predictive value,positive likelihood ratioand negative likelihood ratio of sESAT-6，pESAT-6，sCFP-10,pCFP-10,sT-SPOT andpT-SPOT to diagnosis tuberculosis pleural effusion were85.29%、90%、90.63%、84.38%、8.53、0.16；79.41%、93.33%、93.10%、80%、11.91、0.22；91.18%、83.33%、86.11%、89.29%、5.47、0.11；91.18%、83.33%、86.11%、89.29%、5.47、0.11；88.24%、86.67%、88.24%、86.7%、6.62、0.14；91.18%、83.33%、86.11%、89.29%、5.47、0.11respectively.The ROC area,cut-off value, sensitivity and specificity were0.877、11、85.3%、90%，0.903、11、79.4%、93.3%，0.929、14.5、91.2%、83.3%and0.937、30、88.2%、90%.Conclusion The T-SPOT.TB assay could be used to detect TB infection and to assistthe diagnosis for tuberculosis pleural effusion,because of its high sensitivity andspecificity.

        T-SPOT.TB試驗在結(jié)核性胸腔積液診斷中的應(yīng)用價值

英文縮略詞表5-6中文摘要6-8Abstract8-9引言10-12材料和方法12-16結(jié)果16-21討論21-27結(jié)論27-28參考文獻28-33附錄33-34致謝34-35綜述35-48    參考文獻43-48

  本文關(guān)鍵詞：T-SPOT.TB試驗在結(jié)核性胸腔積液診斷中的應(yīng)用價值，由筆耕文化傳播整理發(fā)布。