| Backgroud:Pneumoconiosis is a systemic disease that occur in Coal workers mainly due to the longtime inhalation of coal dust during work on pulmonary tissue.Pneumoconiosis is one of the most dangerous occupational diseases in china.Pneumoconiosis not only damages the mental and physical health of the patients but it also brings a certain influence on the social development and stability,being a public health problem which is concerned by the society.Coal workers with pneumoconiosis are mainly infected by Tuberculosis.Promote coal workers view on pneumoconiosis which causes rapid progression of tuberculosis,which is the major reason for the increase in mortality of coal workers with pneumoconiosis.Most of the patients with tuberculosis infection initially shows infection and later develops into active tuberculosis.Pneumoconiosis is complicated with tuberculosis in Coal workers because of the tissue reaction caused by dust and Mycobacterium tuberculosis,which leads to the complicated pathological basis,the clinical symptoms and chest X-ray are two diagnostic ways of the original features of the pneumoconiosis and tuberculosis disease but with great difficulties.Coal workers with pneumoconiosis shows impaired lung function because of lung disease because of decreased immunity,tuberculin skin test and sputum smear staining are usually negative,imaging manifestation is not typical,showing the complex and varied forms.Therefore,the diagnosis of pneumoconiosis patients complicated with Mycobacterium tuberculosis infection requires a sensitivity and specificity of the auxiliary examination to improve the diagnostic rate.ELISA detection of serum tuberculosis antibody is commonly used in clinical detection of Mycobacterium tuberculosis infection as an auxiliary means,is a humoral immune diagnostic technology,but its specificity is not high,the diagnostic role is limited.T lymphocyte spot test(T-SPOT.TB)antigen is the early secretory antigen target-6(ESAT-6)and the culture filtrate protein-10(CFP-10)of Mycobacterium tuberculosis.ESAT-6 and CFP-10 are low molecular weight proteins isolated from the culture filtrate in the short time,excellent immunogenicity are two,from the genome of Mycobacterium tuberculosis(of difference 1 region difference,RD1)gene encoding with specific proteins,these proteins of Mycobacterium tuberculosis is unique,does not exist in BCG and non-tuberculosis Mycobacterium tuberculosis infection,which can stimulate T lymphocyte secretion of interferon gamma(interferon y,IFN-y)immune response,sensitive ELISPOT method can detect those IFN-secretion of T lymphocytes,can be used in the early diagnosis of tuberculosis infection.Compared with simple pulmonary tuberculosis,Does T-SPOT.TB have high sensitivity and specificity in the diagnosis of pneumoconiosis associated with tuberculosis? Anti-TB treatment before and after the changes in the efficacy of evaluation whether it makes sense is not clear?Objective:T-SPOT.TB and ELISA were used to detect serum TB antibody,sputum smear acid-fast staining,sputum Mycobacterium tuberculosis culture results were compared,T-SPOT.TB positive patients with active tuberculosis in the standard program of anti-tuberculosis treatment 6 Month after the number of spots compared with the treatment before treatment,evaluation of T-SPOT.TB pneumoconiosis in coal workers with tuberculosis infection in patients with clinical diagnosis and treatment.Methods:Select July 2014 to December 2015 Yu Jiangxi province,Yi'chun city,people hospital infection section,and breathing medical and Jiangxi province people hospital breathing medical visits of coal workers lung dust calm disease merged TB infection patients,and coal workers lung dust calm disease patients,and simple tuberculosis patients total 96 cases,divided into three group,35 cases coal workers pneumoconiosis merged TB group,coal workers pneumoconiosis group 29 cases,tuberculosis group 32 cases' T-SPOT.TB was detected in all patients and serum TB antibody was detected by ELISA,acid-fast staining in sputum smear,mycobacterium tuberculosis in sputum culture.All patients were diagnosed according to clinical symptoms,radiological findings,laboratory findings and treatment follow-up.The results of T-SPOT.TB and ELISA in tuberculosis group of coal worker's pneumoconiosis were compared with the results of serum TB antibody test,sputum smear acid-fast staining test and sputum Mycobacterium tuberculosis culture test the number of T-SPOT.TB spots in the positive patients was compared with 6 months before the treatment from the standard anti-tuberculosis treatment.Results:1.Tuberculosis infection in spot test of T lymphocytes(T-SPOT.TB): there were 35 cases of coal workers ' pneumoconiosis combined with tuberculosis,of which 32 were positive,negative 3 cases,positive rates 91.4%;total of 29 cases of coal workers ' pneumoconiosis group,of which 4 were positive,negative in 25 cases,positive rates 13.8%;32 cases of pulmonary tuberculosis,30 were positive and negative in 2 cases,positive rates of 93.7%.2.ELISA of tuberculosis antibody test in serum: there were 35 cases of coal workers ' pneumoconiosis combined with tuberculosis,of which 14 were positive,negative 21 cases,positive rates 40%;total of 29 cases of coal workers ' pneumoconiosis group,of which 5 were positive,negative 24 cases,positive rates 17.2%;32 cases of tuberculosis,15 were positive,negative in 17 cases,positive rates of 46.8%.3.sputum smear acid-fast staining: there were 35 cases of coal workers ' pneumoconiosis combined with tuberculosis,of which 7 were positive,negative in 28 cases,positive rates 20%;total of 29 cases of coal workers ' pneumoconiosis group,of which 0 were positive,negative 29;32 cases of pulmonary tuberculosis,10 were positive,negative in 22 cases,positive rates of 31.2%.4.Sputum Cultivation of Mycobacterium tuberculosis: there were 35 cases of coal workers ' pneumoconiosis combined with tuberculosis,of which 9 were positive,negative 26 cases,positive rates 25.7%;total of 29 cases of coal workers ' pneumoconiosis group,of which 0 were positive,negative 29;32 cases of pulmonary tuberculosis,11 were positive,negative 21 cases,positive rates of 34.3%.5.T-SPOT of pneumoconiosis coal workers ' combined with tuberculosis.TB-positive patients before treatment A and B antigens spot were 76(42-118),110(50-215)after 6 months of treatment A and B antigens spot number was 27(6-54),52(8-119).6.T-SPOT.TB positive patients in the pulmonary tuberculosis group were treated with antigen A and B antigen spot points were 81(47-126),107(49-209);6 months after treatment,the A antigen and B antigen spot were 30(10-59),48(6-114),respectively.Tuberculosis infection in spot test of T lymphocytes(T-SPOT.TB),and ELISA method serum TB antibody,and phlegm smear anti-acid dyeing,and phlegm TB points branch Bacillus training four species method detection coal workers pneumoconiosis merged TB group of sensitivity respectively for 91.4%,and 40%,and 20%,and 25.7%,which T-SPOT.TB sensitivity(91.4%)highest,and other three species method compared,differences has significantly statistics meaning(p value are <0.01);four species method detection simple tuberculosis group of sensitivity respectively for 93.7%,and 46.8%,and 31.2 %?34.3%,T-SPOT.TB and the other three methods,the difference was statistically significant(P < 0.01),the two groups were significantly higher than the positive rate of T-SPOT.TB CWP group(P < 0.01),while T-SPOT.TB in the sensitivity of pneumoconiosis combined with tuberculosis group and pulmonary tuberculosis group had no significant difference(P > 0.05).The specificity of the four methods were 86.2%,82.8%,100%,100%,T-SPOT.TB and the other 0.05 methods(no significant difference compared with the other three methods(P).The positive predictive values of the four methods were 93.9%,85.2%,100%,100%,T-SPOT.TB compared with the other three methods,the difference was not statistically significant(p >0.05).Four methods of detecting negative predictive values were 83.3%,38.7%,36.7%,38.1%,T-SPOT.TB and negative predictive value(83.3%),compared with the other three methods,the difference was statistically significant(p <0.01).Coal workers ' pneumoconiosis combined with tuberculosis group and group of tuberculosis in T-SPOT.TB spots after treatment than before treatment were significantly decreased(p <0.05),but no significant differences found between the two groups(p >0.05).Conclusions:Tuberculosis infection in spot test of t lymphocytes(T-SPOT.TB)of coal workers pneumoconiosis complicated with tuberculosis infection has a high sensitivity,high negative predictive value characteristics,specificity,positive predictive value and the ELISA method for detection of serum antibody to tuberculosis,sputum smear acid staining,cultivation of Mycobacterium tuberculosis in sputum these traditional laboratory methods,dynamic detection of changes in the amount of its efficacy may be helpful to assess the effect. |
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