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山东大学学报（医学版） ›› 2016, Vol. 54 ›› Issue (6): 82-86.doi: 10.6040/j.issn.1671-7554.0.2015.713

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免疫性疾病患者T-SPOT.TB筛查结果及影响因素

盖林林1*,管立学2*,李海波2,褚锦锦2,朱芸3,李明3   

  1. 1.潍坊医学院临床检验诊断学教研室, 山东 潍坊 261053;2.潍坊市人民医院中心实验室, 山东 潍坊 261041;3.潍坊市人民医院风湿免疫科, 山东 潍坊 261041
  • 收稿日期:2015-07-29 出版日期:2016-06-20 发布日期:2016-06-20
  • 通讯作者: 管立学. E-mail:1832996383@qq.com*并列第一作者 E-mail:1832996383@qq.com
  • 基金资助:
    潍坊市科技发展计划(卫生部分)(2015WS005)

Screening results and influencing factors of T-SPOT.TB assay in patients with autoimmune rheumatic diseases

GAI Linlin1*, GUAN Lixue2*, LI Haibo2, CHU Jinjin2, ZHU Yun3, LI Ming3   

  1. 1. Department of Clinical Laboratory Diagnostics, Weifang Medical University, Weifang 261053, Shandong, China;
    2. Central Laboratory, Weifang Peoples Hospital, Weifang 261041, Shandong, China;
    3. Department of Rheumatology, Weifang Peoples Hospital, Weifang 261041, Shandong, China
  • Received:2015-07-29 Online:2016-06-20 Published:2016-06-20

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摘要： 目的 探讨风湿免疫性疾病患者潜伏结核感染(LTBI)状况及影响结核感染T细胞斑点试验(T-SPOT.TB)结果的相关因素。方法 选取2013年6月至2014年6月风湿免疫性疾病患者223例(病例组)和健康人群53例(健康对照组),抽取外周血,应用结核分枝杆菌特异性抗原ESAT-6和CFP-10刺激,对致敏T细胞应答反应进行检测,并记录糖皮质激素和改善病情的抗风湿药物(DMARDs)应用情况及LTBI高危因素。 结果 病例组T-SPOT.TB阳性检出率20.18%,显著高于健康对照组5.66%;病例组发生结核菌感染的相对风险(OR)是健康对照组的4.21倍(95%CI:1.21~14.70, P<0.05)。病例组T-SPOT.TB阳性检出率和发生LTBI的风险存在明显差异(P<0.01),结节性红斑患者T-SPOT.TB阳性检出率高达44%,发生结核菌感染的风险是健康对照组的13.11倍(95%CI:3.44~49.98, P<0.01);类风湿关节炎患者阳性率21.16%(OR=4.47,95%CI: 1.06~18.82, P<0.05);其他风湿免疫性疾病T-SPOT.TB阳性检出率10.0%~33.34%(OR=1.85~8.33, P>0.05)。T-SPOT.TB阳性和阴性应用糖皮质激素和DMARDs 治疗患者所占比例差异均无统计学意义(P>0.05);既往TB感染史和CT检查结果异常与T-SPOT.TB阳性结果呈显著相关性(P<0.01)。 结论 风湿免疫性疾病患者发生LTBI风险是健康对照组的4.21倍,T-SPOT.TB试验受激素及DMARDs药物影响较小,是LTBI筛查的有效方法。

关键词: 风湿免疫性疾病, 结核感染相对风险度, 筛查, 潜伏结核感染, 影响因素

Abstract: Objective To investigate the status of latent tuberculosis infection(LTBI)in patients with autoimmune rheumatic diseases and the factors associated with a T-cell enzyme-linked immunospot assay(T-SPOT.TB). Methods During June 2013 and June 2014, a total of 223 patients with various autoimmune rheumatic diseases(patient group)and 53 healthy subjects(control group)were enrolled and screened for LTBI by T-SPOT.TB tests. Data on tuberculosis exposure, use of glucosteroid and disease-modifying anti-rheumatic drugs(DMARDs), BCG vaccination history and abnormal CT scans were collected. Miettinen test was used to estimate odds ratios(OR)and 95% confidence intervals(CI). Results T-SPOT.TB-positive rate was 20.18% in the patient group and 5.66% in the control group, and the patient group had higher risk of LTBI(OR=4.21, 95%CI: 1.21-14.70, P<0.05). There were significant 山 东 大 学 学 报 (医 学 版)54卷6期 -盖林林,等.免疫性疾病患者T-SPOT.TB筛查结果及影响因素 \=-differences in T-SPOT.TB-positive rate and OR among various autoimmune rheumatic diseases. The T-SPOT.TB positive rate was 44.0% in patients with erythema nodosumts(OR=13.11, 95%CI: 3.44-49.98, P<0.01), and 21.16% in patients with rheumatoid arthritis(RA)(OR=4.47, 95%CI: 1.06-18.82, P<0.05), obviously higher than that of controls. The T-SPOT.TB positive rate in patients with other rheumatic autoimmune diseases was 10.0%-33.34%(OR=1.85-8.3, P>0.05). There were no significant differences between the proportions of patients treated with glucocorticoid and DMARDs in T-SPOT.TB-positive and T-SPOT.TB-negative groups(P>0.05). Previous active TB and an abnormal CT examination were significantly associated with T-SPOT.TB-positive rate(P<0.01). Conclusion Patients with autoimmune rheumatic diseases are at increased risk of LTBI(OR=4.21). The glucocorticoid and DMARDs treatment have little effect on T-SPOT.TB results. It is an effective method to screen LTBI with T-SPOT.TB in patients with autoimmune rheumatic diseases.

Key words: Influencing factors, Relative risk of tuberculosis infection, Latent tuberculosis infection, Screening, Autoimmune rheumatic diseases

中图分类号: 

  • R735.2
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