Applied Research of T cell Enzyme-linked Immunospot Tuberculous Test in the Clinical Diagnosis of Children's Tuberculosis_West China Medical Journal

Authors：

 XINChao-xiong ¹ , WANGHong-wu ² , WUXiao-xia ¹ , ZHENGWei-jiao ¹ , CHENHui-fen ¹

1. Medical Department, Anti-TB Institute of Shantou, Shantou, Guangdong 515031, P. R. China;
2. Department of Pediatrics, the Second Affiliated Hospital of Shantou University, Shantou, Guangdong 515036, P. R. China;

Corresponding?author：

Keywords：

Tuberculosis; Diagnosis; Children; T cell enzyme-linked immunospot tuberculous test

DOI：

10.7507/1002-0179.20140450

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Objective To investigate the application value of tuberculosis T cell test (T-SPOT.TB) in the clinical diagnosis of children's tuberculosis. Methods The children were selected from Anti-TB Institute of Shantou and the Second Affiliated Hospital of Shantou University from March to December, 2012; they were classified into 4 groups:tuberculosis group (112 cases), non-tuberculosis group (58 cases), high risk of tuberculosis group (60 cases) and healthy control group (60 cases). In each group, the T-SPOT.TB, tuberculin test (PPD), tuberculosis antibody detection (TB-DOT), the sputum smear acid fast stain, and the sputum mycobacterium tuberculosis culture were performed. The sensitivity and specificity of each clinical testing method was compared. The statistical analysis was also performed in the tuberculosis group according to subsection grouping:negative/positive tuberculosis culture, the in-pulmonary/extrapulmonary tuberculosis and the normal immune/immunodeficiency hosts. Results In the tuberculosis group, the T-SPOT.TB has a diagnostic positive rate of 92.9%, significantly higher than that of other clinical testing methods (χ²=9.33, P<0.01; χ²=81.71, P<0.01; χ²=142.00, P<0.01; χ²=101.71, P<0.01). In the non-tuberculosis group, the T-SPOT.TB has a false diagnostic positive rate of 3.4%, a little higher than that of sputum smear and sputum culture, but similar to that of TB-DOT, and much lower than that of PPD test (27.6%; χ²=12.89, P<0.01). In the high risk of tuberculosis group, the T-SPOT.TB has a diagnostic positive rate of 25.0%, higher than that of TB-DOT, sputum smear and sputum culture (P<0.05). In the healthy control group, the T-SPOT.TB has a specificity of 95.0%, significantly higher than that of PPD test (71.7%; χ²=11.76, P<0.01). T-SPOT.TB has a good sensitivity in all of the subsection groups:negative/positive tuberculosis culture, the in-pulmonary/extrapulmonary tuberculosis and the normal immune/immunodeficiency hosts (P>0.05). The total coincidence rate of T-SPOT.TB with the PPD test result was 78.6%. Conclusion T-SPOT.TB has a relatively higher sensitivity and specificity in the diagnosis of children's tuberculosis. With objective and accurate results and less interference factors, it shows a relatively higher clinical application value in the diagnosis of children's tuberculosis.

Citation： XINChao-xiong, WANGHong-wu, WUXiao-xia, ZHENGWei-jiao, CHENHui-fen. Applied Research of T cell Enzyme-linked Immunospot Tuberculous Test in the Clinical Diagnosis of Children's Tuberculosis. West China Medical Journal, 2014, 29(8): 1464-1468. doi: 10.7507/1002-0179.20140450 Copy

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1. Zar HJ. Tuberculosis in the developing world[J]. Pediatr Pulmonol Soppl, 2004, 26(1):53-54.
2. World Health Organization. Global tuberculosis control 2011[R/OL]. Geneva:World Health Organization, 2012. (2011-11-07)[2012-11-16]. http://www.who.int/tb/publications/globalreport/2011/gtbr11full.pdf.
3. 中華醫學會兒科學分會呼吸學組, 《中華兒科雜志》編輯委員會. 兒童肺結核的臨床診斷標準和治療方案(試行)[J]. 中華兒科雜志, 2006, 44(4):249-251.
4. 王黎霞, 成詩明, 趙順英, 等. 中國兒童結核病防治手冊[M]. 北京:人民衛生出版社, 2011:32-33.
5. 唐神結, 高文. 臨床結核病學[M]. 北京:人民衛生出版社, 2011:341.
6. Mazurek GH, Jereb J, Vernon A, et al. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection-United States, 2010[J]. MMWR Recomm Rep, 2010, 59(RR/5):1-25.
7. Nahid P, Pai M, Hopewell PC. Advances in the diagnosis and treatment of tuberculosis[J]. Proc Am Thorac Soc, 2006, 3(1):103-110.
8. 陶波山. 結核分枝桿菌早期分泌抗原靶6的研究進展及應用[J]. 中國防癆雜志, 2011, 33(12):827-830.
9. Dillon DC, Alderson MR, Day CH, et al. Molecular and immunological characterization of Mycobacterium tuberculosis CFP-10, an immunodiagnostic antigen missing in Mycobacterium bovis BCG[J]. Clin Microbiol, 2000, 38(9):3285-3290.
10. Sorensen AL, Nagai S, Houen G, et al. Purification and characterization of a low molecular-mass T-cell antigen secreted by Mycobacterium tuberculosis[J]. Infect Immun, 1995, 63(5):1710-1717.
11. 王榮堂, 陳春梅, 朱曉華, 等. 體外釋放酶聯免疫法檢測結核桿菌γ-干擾素的實驗研究[J]. 中國衛生檢驗雜志, 2011, 21(5):1163-1164, 1166.
12. Nishimura T, Hasegawa N, Mori M, et al. Accuracy of an interferon gamma release assay to detect active pulmonary and extra-pulmonary tuberculosis[J]. Int J Tuberc Lung Dis, 2008, 12(3):269-274.
13. Diel R, Loddenkemper R, Meywald-Walter K, et al. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis[J]. Am J Respir Crit Care Med, 2008, 177(10):1164-1170.
14. Doherty TM. Immune responses to the Mycobacterium tuberculosis-specific antigen ESAT-6 signal subclinical infection among contacts of tuberculosis patients[J]. Clin Microbiol, 2002, 40(2):704-706.
15. Brodie D, Lederer DJ, Gallardo JS, et al. Use of an interferongamma release assay to diagnose latent tuberculosis infection in foreign-born patients[J]. Chest, 2008, 133(4):869-874.
16. 譚守勇, 譚耀駒, 鄺浩斌, 等. 肺結核并低蛋白血癥對細胞免疫功能的影響[J]. 中國自然醫學雜志, 2010, 12(3):161-163.
17. Brock I, Ruhwald M, Lundgren B, et al. Latent tuberculosis in HIV positive, diagnosed by the M. tuberculosis specific interferon-γ test[J]. Respir Res, 2006, 7(1):56-64.

West China Medical Journal

Applied Research of T cell Enzyme-linked Immunospot Tuberculous Test in the Clinical Diagnosis of Children's Tuberculosis

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