本文選題：活動(dòng)性結(jié)核病　切入點(diǎn)：結(jié)核抗體　出處：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景近年來(lái)隨著結(jié)核病基礎(chǔ)研究的迅速發(fā)展,在免疫學(xué)檢測(cè)方面已先后開(kāi)展了一些較為可靠的結(jié)核病檢測(cè)方法,尤其近年研發(fā)的一種新技術(shù)——結(jié)核感染T細(xì)胞斑點(diǎn)試驗(yàn)(T-SPOT.TB),已在許多歐美國(guó)家得到認(rèn)可并被應(yīng)用于臨床診斷。但在我國(guó)由于存在較高的結(jié)核潛伏感染率,對(duì)于此種檢測(cè)方法在結(jié)核病診斷中的應(yīng)用仍存在爭(zhēng)議,因此我們進(jìn)行以下研究來(lái)進(jìn)一步評(píng)價(jià)T-SPOT.TB在結(jié)核病診斷中的應(yīng)用價(jià)值。目的通過(guò)將T-SPOT.TB分別與血清結(jié)核抗體檢測(cè)、皮膚結(jié)核菌素試驗(yàn)在疑診活動(dòng)性結(jié)核病患者中的檢測(cè)結(jié)果進(jìn)行比較分析,并比較活動(dòng)性結(jié)核患者與結(jié)核潛伏感染者T-SPOT.TB陽(yáng)性結(jié)果的斑點(diǎn)數(shù),來(lái)評(píng)價(jià)T-SPOT.TB在結(jié)核病診斷中的應(yīng)用價(jià)值。方法前瞻性納入2013年3月至2013年11月新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院住院患者中疑診活動(dòng)性結(jié)核病的患者167例,進(jìn)行T-SPOT.TB、血清結(jié)核抗體、結(jié)核菌素試驗(yàn)檢測(cè)。依據(jù)輔助檢查結(jié)果、臨床療效觀察及長(zhǎng)時(shí)間隨訪結(jié)果等依據(jù)最終確定診斷,將上述三項(xiàng)檢測(cè)結(jié)果與最終臨床診斷相對(duì)比,以敏感性、特異性、陽(yáng)性似然比、陰性似然比、符合率、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值為評(píng)價(jià)指標(biāo),將T-SPOT.TB分別與血清結(jié)核抗體、皮膚結(jié)核菌素試驗(yàn)進(jìn)行比較。分別分析年齡、營(yíng)養(yǎng)不良及重癥結(jié)核對(duì)T-SPOT.TB敏感性的影響。統(tǒng)計(jì)活動(dòng)性結(jié)核患者與結(jié)核潛伏感染者T-SPOT.TB陽(yáng)性結(jié)果斑點(diǎn)數(shù)并進(jìn)行比較分析。結(jié)果(1)T-SPOT.TB、吉核抗體檢測(cè)、結(jié)核菌素試驗(yàn)的敏感性分別為90%、28%、55%,T-SPOT.TB分別與另兩項(xiàng)檢測(cè)方法相比,差異有統(tǒng)計(jì)學(xué)意義(P0.001)(2)T-SPOT.TB、結(jié)核抗體檢測(cè)、結(jié)核菌素試驗(yàn)的特異性分別為81.3%、79.1%、76.9%, T-SPOT.TB分別與另兩項(xiàng)檢測(cè)方法相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(PO.05)。(3) T-SPOT.TB、結(jié)核抗體檢測(cè)、結(jié)核菌素試驗(yàn)的陽(yáng)性似然比分別為4.813、1.34、2.38,陰性似然比分別為0.12、0.91、0.59,T-SPOT.TB的陽(yáng)性似然比最高,陰性似然比最低。(4) T-SPOT.TB、結(jié)核抗體檢測(cè)、結(jié)核菌素試驗(yàn)符合率分別為84.8%、58.9%、68.2%, T-SPOT.TB分別與另兩項(xiàng)檢測(cè)方法相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5) T-SPOT.TB、結(jié)核抗體檢測(cè)、結(jié)核菌素試驗(yàn)的陽(yáng)性預(yù)測(cè)值分別為76%、47%、61%, T-SPOT.TB與結(jié)核抗體檢測(cè)相比存在統(tǒng)計(jì)學(xué)差(P0.05),與結(jié)核菌素試驗(yàn)相比無(wú)統(tǒng)計(jì)學(xué)差異(PO.05)。(6) T-SPOT.T B、結(jié)核抗體檢測(cè)、結(jié)核菌素試驗(yàn)的陰性預(yù)測(cè)值分別為93%、62.6%、72.7% 。 T-SPOT.TB分別與另兩項(xiàng)檢測(cè)方法相比,差異有統(tǒng)計(jì)學(xué)意義(PO.001)。(7)營(yíng)養(yǎng)不良組與無(wú)營(yíng)養(yǎng)不良組、老年組與非老年組、重癥結(jié)核組與非重癥結(jié)核組T-SPOT.TB敏感性比較均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(8)活動(dòng)性結(jié)核患者與結(jié)核潛伏感染者T-SPOT.TB陽(yáng)性結(jié)果抗原A孔斑點(diǎn)中位數(shù)分別為21與14,二者比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),抗原B孔斑點(diǎn)數(shù)中位數(shù)分別為25與3,二者比較有統(tǒng)計(jì)學(xué)差異(PO.05)結(jié)論T-SPOT.TB是一種診斷結(jié)核病的較好方法,陰性結(jié)果對(duì)排除活動(dòng)性結(jié)核病的診斷價(jià)值較高。陽(yáng)性結(jié)果對(duì)判斷結(jié)核是否活動(dòng)作用有限。
[Abstract]:Background with the rapid development of basic research on tuberculosis in recent years, some reliable methods of tuberculosis detection have been carried out in immunology. In particular, a new technique developed in recent years-T-SPOT.TBX, has been recognized in many European and American countries and has been used in clinical diagnosis. However, because of the high latent infection rate of TB in China, The application of T-SPOT.TB in the diagnosis of tuberculosis is still controversial, so we do the following research to further evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. The results of skin tuberculin test in suspected active tuberculosis patients were compared, and the number of T-SPOT.TB positive spots in active tuberculosis patients and latent tuberculosis patients were compared. To evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. Methods from March 2013 to November 2013, 167 patients with suspected active tuberculosis were included in the first affiliated Hospital of Xinxiang Medical College. According to the results of auxiliary examination, clinical efficacy observation and long-term follow-up, the final diagnosis was determined. The results of the above three tests were compared with the final clinical diagnosis, with sensitivity, specificity, positive likelihood ratio, etc. Negative likelihood ratio, coincidence rate, positive predictive value and negative predictive value were evaluated. T-SPOT.TB was compared with serum tuberculosis antibody and skin tuberculin test. Effects of malnutrition and severe tuberculosis on T-SPOT.TB susceptibility. The number of T-SPOT.TB positive spots in active TB patients and latent TB patients were analyzed and compared. The sensitivity of the tuberculin test was 90%. The sensitivity of the TSPOT.TB test was significantly higher than that of the other two methods. The specificity of the TB antibody test was 81.3% and 79.1%, respectively, and the T-SPOT.TB test was compared with the other two methods, respectively, and the specificity of the tuberculin test was 79.9%. The T-SPOT.TB test was compared with the other two methods. There was no significant difference in T-SPOT.TB. the positive likelihood ratio of tuberculin test was 4.8131.34 ~ 2.38, and the negative likelihood ratio was 0.120.91 ~ 0.59% T-SPOT.TB was the highest, and the negative likelihood ratio was the lowest) T-SPOT.TB, TB antibody test, TB antibody test, T-SPOT.TB, TB antibody test, the positive likelihood ratio of T-SPOT.TB was the highest, the negative likelihood ratio was the lowest, and the positive likelihood ratio of TB antibody test was 4.8131.34, and the negative likelihood ratio of T-SPOT.TB was the highest and the lowest. The coincidence rates of tuberculin test were 84.8% and 58.9%, respectively. Compared with the other two methods, T-SPOT.TB was significantly different from the other two methods. The positive predictive values of the tuberculin test were 76 and 4761.The T-SPOT.TB was significantly lower than the tuberculosis antibody test (P0.05), and there was no statistical difference compared with the tuberculin test (P < 0.05. 0. 6) T-SPOT.TB. The negative predictive values of tuberculin test were 93.62.6% and 72.7%, respectively. T-SPOT.TB was significantly different from the other two methods (P < 0.01). There was no significant difference in the sensitivity of T-SPOT.TB between the patients with severe tuberculosis and those with non-severe tuberculosis (P 0.05. 05). The median of T-SPOT.TB positive results of T-SPOT.TB positive spots in active TB patients and latent TB patients was 21 and 14, respectively. There was no significant difference between the two groups. The median number of antigenic B hole spots was 25 and 3, respectively (P < 0.05). Conclusion T-SPOT.TB is a better method for the diagnosis of tuberculosis. The negative results were of high diagnostic value in excluding active tuberculosis, and the positive results were of limited value in judging whether tuberculosis was active or not.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R52
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本文編號(hào)：1576536