酶联免疫斑点试验快速检测结核分枝杆菌感染的应用评价

叶魏，孟成艳，韩晓辉，章琪，贾哲甫，鞠志英，周娴，周启明，李俊，方筠

　　上海国际旅行卫生保健中心，上海 200335

　　摘要：目的 评价γ干扰素释放实验（IGRA）诊断活动性结核病的价值。方法选取130例胸片异常的出入境人员，根据胸片是否存在活动性病变将研究对象分为试验组（60例）和对照组（70例），采取IGRA检测试剂盒TSPOT.TB，测定结核杆菌特异抗原刺激反应的效应T淋巴细胞数量，结合实验室痰菌涂片和培养结果评价该技术对活动性肺结核的筛查价值。结果T-SPOT.TB在筛查临床诊断的活动性肺结核患者中的敏感性与结核菌素皮肤试验（TST）接近，分别为73.3%比78.3%特异性显著优于TST试验（结核菌素皮肤试验），为60%和27.3%；在痰菌检查阳性的活动性肺结核确诊患者和痰菌检查阴性的对照组受试者中，T-SPOT.TB诊断活动性肺结核患者的敏感性和特异性进一步提高，与TST试验相比，敏感性为93.1%比75.9%，特异性为62.7%比35.8%。结论T-SPOT.TB检测活动性肺结核的敏感性高，优于传统的TST方法，提示该技术可用于在临床疑似结核病患者中快速筛查活动性肺结核。

　　关键词：酶联免疫斑点技术；结核分枝杆菌；快速检测；应用评价

　　中图分类号：R183.3　文献标识码：B

　　Analysis of a new rapid method for diagnosis on Tuberculosisinfection

　　YE Wei, MENG Cheng-yan, HAN Xiao-hui, ZHANG Qi, JIA Zhe-pu, JUZhi-ying,

　　ZHOU xian, ZHOU Qi-ming, LI Jun, FANG Yun

　　Shanghai International Travel Health Care Center, Shanghai200335, China

　　Abstract:   Objective   To evaluate the performance ofγ Interferon releasing assay (IGRA) in the screening of activepulmonary tuberculosis (TB).  Methods   A total of 130 TBsuspected cases with chest X-ray abnormality from the populationwho accepted physical examination at Shanghai port were dividedinto two groups: clinically diagnosed active TB group andnon-active TB control group. One international launched commercialIGRA kit (T-SPOT.TB assay, Oxford lmmunotec Ltd from England) wasused to detect the blood samples and the results were compared withthe results of routine diagnosis methods including TB skin test(TST) and sputum smear and culture.   Results   Inclinical suspected active pulmonary TB cases, the sensitivity ofT-SPOT.TB was close to TST(73.3% vs. 78.3%),the specificity ofT-SPOT.TB were higher than TST (60% vs.27.3%). While combining theresults of sputum bacteriological examination, the sensitivity,specificity of T-SPOT.TB increased to 93.1 % and 62.7%, much higherthan those of TST (75.9% and 35.8%). Conclusion   T-SPOT.TB ismore sensitive and specific than TST in the diagnosis of activepulmonary TB and identification of suspected cases with activetuberculosis.

　　Key words:   ELISPOT; Tuberculosis; Rapid diagnosis;Evaluation

　　《中国国境卫生检疫杂志》2013年12月刊