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目的通过γ干扰素释放试验探讨结核分枝杆菌特异性效应T细胞斑点数(简称T细胞斑点数)鉴别儿童活动性结核病(TB)与潜伏结核感染(LTBI)的价值。方法纳入T细胞斑点试验(T.SPOT.TB)阳性且未经过抗结核治疗的93例活动性TB(重症TB27例,非重症TB66例)和47例LTBI儿童,根据T.SPOT.TB结果对T细胞斑点数进行比较分析。结果活动性TB组T细胞斑点数中位数84(6～710)显著高于LTBI组17(6～316),P=0.000;非重症TB患儿的T细胞斑点数中位数为99(6～710),显著高于重症TB的44(6～268),P=0.011,也显著高于LTBI组17(6～316),P=0.000;重症TB儿童T细胞斑点数中位数高于LTBI组儿童(44vs17),但差异无统计学意义(P=0.084),T细胞斑点数分布在活动性TB、重症TB、非重症TB和LTBI之间均有较大范围重叠。受试者工作特征曲线分析显示以T细胞斑点数43.5作为区分活动性TB与LTBI的最佳界值,其敏感度与特异度分别为69.9%和70.2%。结论 T细胞斑点数在活动性TB尤其是非重症TB患儿显著高于LTBI儿童;T细胞斑点数的数量可反映体内的结核分枝杆菌负荷,但不能用于区分儿童活动性TB与LTBI。
Objective To investigate the value of T cell spot count (T cell spot number) of Mycobacterium tuberculosis to identify active tuberculosis (TB) and latent tuberculosis infection (LTBI) in children through γ interferon release test. Methods Ninety-three cases of active TB (severe TB, non-severe TB, 66 cases) and 47 children with LTBI who were positive for T-cell spot test (T.SPOT.TB) and without anti-TB treatment were enrolled. According to the results of T.SPOT.TB T cell spots for comparative analysis. Results The median number of T cell spots in active TB group was significantly higher than that in LTBI group 84 (6-710) (P <0.05), while the median number of T cell spots in non TB patients was 99 6 to 710), which was significantly higher than that of 44 (6 ~ 268) of severe TB, P = 0.011, also significantly higher than LTBI group 17 (6 ~ 316), P = 0.000; There were no significant differences between the LTBI group and the LTBI group (44 vs 17) (P = 0.084). The distribution of T cell spots showed a wide range of overlap between active TB, severe TB, non-severe TB and LTBI. Analysis of receiver operating characteristic curves showed that the sensitivity and specificity of T cell spot 43.5 as the best cutoff between active TB and LTBI were 69.9% and 70.2% respectively. Conclusions The number of T cell spots in children with active TB, especially those with non-severe TB, is significantly higher than that in LTBI children. The number of T cell spots reflects the burden of Mycobacterium tuberculosis in vivo but can not be used to distinguish between active TB and LTBI in children.