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目的探讨T淋巴细胞亚群及结核感染T细胞斑点试验(T-SPOT.TB)检测对活动性结核病的鉴别诊断价值。方法检测20例健康对照者、26例隐性结核病感染者及35例活动性结核杆菌感染者外周血的T淋巴细胞亚群及T-SPOT.TB。结果隐性感染组、活动性结核组的CD4+细胞、CD8+细胞的表达与健康对照组比较有显著性差异(P均<0.01),而隐性感染组与活动性结核组组间比较无显著性差异(P>0.05)。外周血的CD4+CD25+CD127low细胞、CD39+CD4+CD25+CD127low细胞在健康对照组、隐性感染组及活动性结核组中表达有显著性差异(P均<0.01);T-SPOT.TB诊断隐性感染组的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别是53.8%(14/26)、90.0%(18/20)、87.5%(14/16)、60.0%(18/28)、5.4、0.5;而活动性结核组分别是57.1%(20/35)、90.0%(18/20)、90.9%(20/22)、54.5%(18/33)、5.7、0.5,二组在诊断效率指标上无显著性差异(P>0.05)。结论 CD4+CD25+CD127low细胞与CD39+CD4+CD25+CD127low细胞在活动性结核与隐匿性结核的表达差异或与免疫抑制和免疫耐受的强度有关,是区分二者的优选指标。
Objective To investigate the diagnostic value of T-lymphocyte subsets and T-SPOT.TB in the differential diagnosis of active tuberculosis. Methods T-lymphocyte subsets and T-SPOT.TB in peripheral blood of 20 healthy controls, 26 patients with latent tuberculosis infection and 35 patients with active tubercle bacilli were detected. Results The expression of CD4 + cells and CD8 + cells in latent infection group and active tuberculosis group were significantly different from those in healthy control group (P <0.01), but there was no significant difference between latent infection group and active tuberculosis group Difference (P> 0.05). The expression of CD4 + CD25 + CD127low and CD39 + CD25 + CD127low in peripheral blood was significantly different between healthy control group, latent infection group and active tuberculosis group (all P <0.01); T-SPOT.TB The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 53.8% (14/26), 90.0% (18/20) and 87.5% (20/35), 90.0% (18/20), 90.9% (20/22), 54.5% (20/22), 60.0% (18/28) (18/33), 5.7, 0.5, there was no significant difference in diagnostic efficiency between the two groups (P> 0.05). Conclusion The difference of CD4 + CD25 + CD127low and CD39 + CD4 + CD127low cells in active tuberculosis and occult tuberculosis is related to the intensity of immunosuppression and immune tolerance, which is the preferred index to distinguish the two.