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目的研究酶联免疫斑点试验(ELISPOT)检测胸水γ干扰素效应T细胞对结核性胸膜炎的诊断价值。方法收集解放军第三O九医院临床确诊的120例结核性胸膜炎患者和55例其他原因所致胸膜炎患者(如恶性或炎性反应等)治疗前的胸水单个核细胞(PEMCs)及外周血单个核细胞(PBMCs),用重组CFP10-ESAT6融合蛋白刺激后应用ELISPOT法检测分泌γ干扰素的效应T细胞斑点形成细胞数(SFCs)。结果结核性胸膜炎组(结核组)PBMCs及PEMCs产生的SFCs值均显著高于非结核性胸膜炎组(非结核组)(P<0.01),结核组PBMCs与PEMCs产生的SFCs值差异无统计学意义(P>0.05),但非结核组PBMCs产生的SFCs值显著高于PEMCs(P<0.05)。结核组血和胸水性胸膜炎ELISPOT阳性率分别为62.9%和60.8%,与非结核组36.6%和16.4%比较差异有统计学意义(P<0.05)。结核组血和胸水ELISPOT阳性率比较差异无统计学意义(P>0.05),但非结核组血ELISPOT阳性率显著高于胸水(P<0.05)。依据PEMC ELISPOT结果诊断结核的灵敏度为60%(63/105),特异度为82.9%(34/41),优于PBMCs和PEMC+PBMCs ELISPOT。结论胸水ELISPOT检测是一种较灵敏、特异的结核性胸膜炎辅助诊断和鉴别诊断方法。
Objective To study the diagnostic value of ELISPOT in the detection of pleural effusion IFN-γ T cells in patients with tuberculous pleurisy. Methods A total of 120 cases of tuberculous pleurisy clinically diagnosed in the 309th Hospital of People’s Liberation Army and 55 cases of pleural effusion caused by other causes (such as malignant or inflammatory reaction) were collected before treatment and the peripheral blood mononuclear cells (PEMCs) Cells (PBMCs) were stimulated with recombinant CFP10-ESAT6 fusion protein and ELISPOT method was used to detect the effector T cells (SFCs) secreting interferon gamma. Results The SFCs values of PBMCs and PEMCs in tuberculous pleurisy group (tuberculosis group) were significantly higher than those in non-tuberculous pleurisy group (non-tuberculosis group) (P <0.01). The SFCs of PBMCs and PEMCs in tuberculosis group were not significantly different (P> 0.05). However, SFCs of PBMCs from non-tuberculosis group were significantly higher than PEMCs (P <0.05). The positive rates of ELISPOT in blood and pleural effusion were 62.9% and 60.8% respectively in tuberculosis group and 36.6% and 16.4% in non-tuberculosis group (P <0.05). The positive rates of ELISPOT in blood and pleural effusion in tuberculosis group were not significantly different (P> 0.05), but the positive rate of ELISPOT in non-tuberculosis blood was significantly higher than that in pleural effusion (P <0.05). The sensitivity of the diagnosis of tuberculosis was 60% (63/105) and 82.9% (34/41) based on the PEMC ELISPOT results, outperforming PBMCs and PEMC + PBMCs ELISPOT. Conclusion Pleural effusion ELISPOT test is a sensitive and specific method for the diagnosis and differential diagnosis of tuberculous pleurisy.