T-SPOT.TB在结核性脊柱炎疗效评价中的作用
The Value of T-SPOT.TB in Evaluating Treatment Effect of Tuberculous Vertebral Osteomyelitis
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摘要: 目的 探讨结核感染T细胞试验 (T-SPOT.TB) 中两种抗原ESAT-6及CFP-10在评价结核性脊柱炎治疗效果中的价值.方法 回顾性分析2013年1月至2016年1月就诊于昆明医科大学第一附属医院、T-SPOT.TB (+) , 初治且明确诊断为结核性脊柱炎并随访成功共29例.应用Wilcoxon秩合检验及χ2检验分析ESAT-6及CFP-10在结核性脊柱炎疗效过程中变化.并绘制ESR、CRP、VAS与ESAT-6及CFP-10的散点图进行线性回归分析.结果 ESAT-6及CFP-10治疗前的斑点计数分别与治疗后6个月、12个月及治愈后的斑点计数比较, 治疗6个月时, 斑点计数下降无统计学意义, 治疗12个月及治愈后斑点计数较治疗前明显下降, P<0.05, 差异有统计学意义.CFP-10治疗前的阳性结果分别与治疗后3次随访阳性结果进行χ2检验, 治疗前、治疗后6个月、12个月及治愈后阳性率分别为86.20%、86.20%、75.86%、58.62%, P<0.05, 差异有统计学意义.ESAT-6仅与VAS呈线性相关, 而CFP-10与VAS、ESR均呈线性相关关系, 但是相关性均较弱.结论 ESAT-6及CFP-10的斑点计数下降提示治疗有效, 且CFP-10可能成为评价治疗效果的指标之一.Abstract: Objective To investigate the treatment evaluating value of ESAT-6 and CFP-10 in T-SPOT.TB kit for tuberculous vertebral osteomyelitis.Me dthods This retrospective study analyzed 29 cases diagnosed as TVO in the First Affiliated Hospital of Kunming Medical University from January 2013 to January 2016. All cases were the first-time consultancy. The Wilcoxon-singed-rank-test and chi-square test were used to analyze the changes of ESAT-6 and CFP-10 in the procedure of treatment. The linear-regression analysis was used to analyze the relationship between ESR, CRP, VAS and two specific antigens.Re s ults The pretherapeutic spot counts of ESAT-6 and CFP-10 were compared with the first and the last follow-up respectively. The results of two antigenic spots change showed a higher consistency (P<0.05) .The positive rates of CFP-10 at the prior treatment, the first follow-up and the last follow-up were 86.20%, 79.31% and 58.62% respectively. The result of chi-square test showed a higher consistency (P <0.05) . ESAT-6 only correlated with VAS. CFP-10 had the relationship with VAS and ESR. But all of these relativities were weak.Conclus ion The decrease in the spot counts of ESAT-6 and CFP-10 suggest that the treatment is effective, and CFP-10 may be one available index to evaluate the treatment effect.
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Key words:
- T-SPOT.TB /
- Tuberculous vertebral osteomyelitis /
- ESAT-6 /
- CFP-10 /
- Treatment
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[1] [1]DENKINGER C M, DHEDA K, PAI M.Guidelines on interferon-gamma release assays for tuberculosis infection:concordance, discordance or confusion[J].Clin Microbiol Infect, 2011, 17 (6) :806-814. [2] [2]AHMAD S.New approaches in the diagnosis and treatment of latent tuberculosis infection[J].Respir Res, 2010, 11 (1) :169. [3]李宝田, 焦云龙, 孙文星.T-SPOT.TB检测在脊柱结核诊断中的应用[J].中国骨科临床与基础研究杂志, 2015, 07 (2) :74-78. [4]袁凯, 吴雪琼, 张强, 等.结核杆菌抗原特异性γ干扰素释放试验在脊柱结核辅助诊断中的应用研究[J].实用医学杂志, 2013, 29 (14) :2314-2316. [5]华裕忠, 程绍云, 姜国红, 等.结核菌感染T细胞干扰素释放检测在脊柱结核快速诊断中的应用[J].中华医学杂志, 2016, 96 (27) :2179-2181. [6]张瑛, 孙亚蒙, 徐欣晖, 等.结核感染T细胞斑点试验在结核性疾病中的诊断价值[J].中华临床医师杂志, 2010, 4 (12) :2431-2434. [7]吴阶平, 裘法祖, 吴孟超, 等.黄家驷外科学[M].第7版.北京:人民卫生出版社, 2008:65-70. [8]郭培宇, 李佩明, 张春强, 等.改良标准化疗方案治疗脊柱结核的疗效分析[J].昆明医科大学学报, 2015, 36 (2) :54-57. [9] [9]NICKERSON EK, SINHA R.Vertebral osteomyelitis in adults:an update[J].Br Med Bull, 2016, 117 (1) :121-138. [10]陶学芳, 王华钧, 王建华, 等.T细胞斑点试验在肺结核诊断和疗效评价中的意义[J].中华临床感染病杂志, 2012, 05 (4) :221-224. [11]陶学芳, 王建华, 李永兴, 等.结核感染T细胞酶联免疫斑点试验在肺结核及肺外结核诊断中的价值[J].浙江预防医学, 2012, 24 (11) :4-7. [12]何紫琪, 李从荣.结核感染T细胞斑点试验对结核病治疗效果的监测价值[J].海南医学, 2016, 27 (12) :1923-1925. [13] [13]LEUNG C C, YAM WC, HO P L, et al.T-Spot.TB outperforms tuberculin skin test in predicting development of active tuberculosis among household contacts[J].Respirology, 2015, 20 (3) :496-503. [14] [14]GUPTA D, AGARWAL R, AGGARWAL A N, et al.Immune responses to mycobacterial antigens in sarcoidosis:a systematic review[J].Indian J Chest Dis Allied Sci, 2011, 53 (1) :41-49. [15] [15]HARARI A, VALLELIAN F, MEYLAN P R, et al.Functional heterogeneity of memory CD4 T cell responses in different conditions of antigen exposure and persistence[J].Journnal of Immunology, 2005, 174 (2) :1037-1045. [16] [16]WELIN A, EKLUND D, STENDAHL O, et al.Human macrophages infected with a high burden of ESAT-6-expressing M.tuberculosis undergo caspase-1-and cathepsin B-independent necrosis[J].PLo S One, 2011, 6 (5) :e20302. [17] [17]AIKEN A M, HILL P C, FOX A, et al.Reversion of the ELISPOT test after treatment in Gambian tuberculosis cases[J].Bmc Infectious Diseases, 2006, 6 (1) :1-6. [18] [18]EWER K, MILLINGTON K A, DEEKS J J, et al.Dynamic Antigen-specific T-Cell Responses after Point-Source Exposure to Mycobacterium tuberculosis[J].American Journal of Respiratory and Critical Care Medicine, 2006, 174 (7) :831-839.
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