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目的:研究结核性胸膜炎患者胸水T淋巴细胞(TLC)特异性分泌γ-干扰素(IFN-γ)的免疫反应,为结核性胸水的诊断提供依据。方法:应用淋巴细胞分离技术分离13例结核性胸水和11例恶性胸水TLC,体外利用PPD抗原刺激,用酶联免疫斑点法(ELISPOT)检测两组胸水TLC分泌IFN-γ的免疫反应。每例患者院内常规做PPD试验。结果:结核性胸水TLC分泌IFN-γ的免疫反应阳性率为84.62%(11/13例),明显高于恶性胸水组18.18%(2/11例),两者之间差异有显著性(P<0.01)。ELISPOT和PPD试验的敏感性分别为84.62%,46.15%,两者之间有明显差异性(P<0.01)。而ELISPOT和PPD试验的特异性分别为81.82%,90.91%,两者之间差异不明显。结论:ELISPOT检测结核性胸膜炎的敏感性和特异性均较高,有助于临床上对结核性胸水的鉴别诊断。
Objective: To study the immunoreactivity of IFN-γ secreted by pleural fluid T lymphocytes (TLC) in tuberculous pleurisy patients and provide the basis for the diagnosis of tuberculous pleural effusion. Methods: Thirteen cases of tuberculous pleural effusion and 11 cases of malignant pleural effusion were separated by lymphocyte separation. TLC was stimulated by PPD antigen in vitro. The immunoreactivity of IFN-γ secreted by pleural effusion by TLC was detected by ELISPOT. Every patient in the hospital routine PPD test. Results: The positive rate of IFN-γ secreted by TLC in tuberculous pleural effusion was 84.62% (11/13 cases), significantly higher than that in malignant pleural effusion group (18.18%) (2/11 cases), the difference was significant <0.01). The sensitivities of ELISPOT and PPD were 84.62% and 46.15%, respectively, with significant differences (P <0.01). The specificity of ELISPOT and PPD test were 81.82%, 90.91%, the difference between the two is not obvious. Conclusion: The sensitivity and specificity of ELISPOT in detection of tuberculous pleurisy are high, which is helpful to the differential diagnosis of tuberculous pleural effusion.