| Objectives To analyze the significance of T cell spot test(T-SPOT.TB)combined with transcription factors Blimp1,IFN-? and IL-10 in the diagnosis of active tuberculosis patients and patients with latent tuberculosis infection.Methods Patients with suspected pulmonary tuberculosis who came to our hospital from July 2014 to June 2015 were selected.100 confirmed tuberculosis patients were selected as the case group.50 patients with regular health checkups at the same time were selected as healthy controls.The patients in thecase group were followed up for 3 months.According to the gold standard for tuberculosis diagnosis and the definition of latent tuberculosis infection,the case group was divided into active pulmonary tuberculosis group(active group,n=70)and latent tuberculosis group(referred to as latent group,n =30).Peripheral blood T-SPOT.TB was detected in all samples.The levels of plasma IFN-? and IL-10 were detected by enzyme-linked immunosorbent assay(ELISA),Reverse transcriptase polymerase chain reaction(RT-PCR)was used to detect peripheral blood transcription factor Blimp1 levels in all samples.The differences of Blimp1,IFN-? and IL-10 levels between the groups were compared.The number of spots in each well of T-SPOT.TB positive patients in active group and latent group was compared.The receiver operating characteristic curve(ROC)was used to analyze the efficacy of T-SPOT.TB,Blimp1,IFN-?,IL-10,and the above-mentioned indicators in the diagnosis of active tuberculosis and latent tuberculosis,according to the Yoden index.Determine the best diagnostic value and calculate the diagnostic sensitivity and specificity.Results 1 The age of active group ranged from 19 to 80 years old with an average age of 48.54±18.14 years.The latent group ranged from 22 to 78 years old with an average age of 49.67±16.98 years.2 The results of T-SPOT.TB in each group showed that in the healthy control group,the T-SPOT.TB results showed positive in 0 cases and negative in 50 cases.In the active group,T-SPOT.TB results showed positive in 63 cases and negative in 7 cases.In the latent group,T-SPOT.TB results showed positive in 27 cases and negative in 3 cases.3 There was no significant difference in the number of A-well spots between the T-SPOT.TB-positive patients in the active group and the T-SPOT.TB-positive patients in the latent group(P>0.05).The number of B-well spots was statistically significant.The active group was higher than the latent group(P<0.05),and the difference of A+B hole spots was not statistically significant(P>0.05).4 One-way analysis of variance showed that there were differences in the levels of Blimp1,IFN-? and IL-10 between the groups(P<0.05).The levels of Blimp1,IFN-? and IL-10 in the active group were higher than those in the healthy control group,and the difference was statistically significant(P<0.05).The levels of Blimp1,IFN-? and IL-10 in the active group were higher than those in the latent group,and the difference was statistically significant(P<0.05).The levels of Blimp1,IFN-? and IL-10 in the latent group were higher than those in the healthy control group,and the difference was statistically significant(P<0.05).5 The diagnostic criteria for latent tuberculosis was used as the gold standard.The ROC curve was included in the SPSS software.The results showed that the area under the ROC curve of the Blimp1 diagnosis(AUC)was AUC=0.824,95% CI: 0.741~0.907,P<0.05.When the Yoden index is at most 0.495,the sensitivity is 0.629 and the specificity is 0.867.At this time,the best diagnostic value of Blimp1 is 4.770;the AUC of IFN-? is: AUC=0.854,95% CI: 0.778~0.929,P< 0.05,when the Yoden index is at most 0.595,the sensitivity is 0.729,the specificity is 0.867,and the optimal diagnostic value of IFN-? is 103.95pg/ml;the AUC of IL-10 is: AUC=0.877,95% CI: 0.811~0.944,P<0.05.When the Yoden index is 0.657,the sensitivity is 0.757 and the specificity is 0.900.The best diagnostic value of IL-10 is 119.71pg/ml;the AUC of T-SPOT.TB spots It is: AUC=0.742,95% CI: 0.642~0.842,P<0.05.When the Yoden index is 0.371,the sensitivity is 0.371 and the specificity is 1.000.The best diagnostic value of T-SPOT.TB spots is 87.30.6 T-SPOT.TB was combined with Blimp1,IFN-?,IL-10 to plot ROC.The results showed that the area under the ROC curve(AUC)of T-SPOT.TB combined with Blimp1 diagnosis was AUC=0.826,95%.CI: 0.742~0.910,P<0.05.When the Yoden index is 0.476,the sensitivity is 0.643 and the specificity is 0.833.The AUC of T-SPOT.TB combined with IFN-? is: AUC=0.860,95% CI: 0.788 ~0.933,P<0.05,when the Yoden index is 0.624,the sensitivity is 0.757,the specificity is 0.867;the AUC of T-SPOT.TB combined with IL-10 is: AUC=0.883,95% CI: 0.818~0.948,P<0.05,when the Yoden index is 0.638,the sensitivity is 0.771,the specificity is 0.867;the AUC of T-SPOT.TB combined with Blimp1,IFN-? and IL-10 is: AUC=0.973,95% CI: 0.948 ~0.998,P<0.05,when the Yoden index is at most 0.833,the sensitivity is 0.900 and the specificity is 0.933.Conclusions 1 Blimp1,IFN-?,IL-10 are different between active tuberculosis and latent tuberculosis patients.Blimp1,IFN-? and IL-10 may be involved in the body's antituberculosis immune response.2 The value of Blimp1,IFN-? and IL-10 alone in the diagnosis of active tuberculosis and latent tuberculosis is still limited.The value of combined diagnosis of T-SPOT.TB,Blimp1,IFN-? and IL-10 are bigger.3 In clinical work,the number of spots in B-well of T-SPOT.TB is >87.30,the relative gray value of peripheral blood Blimp1 mRNA is >4.770,the IFN-? value is >103.95pg/ml,and the IL-10 value is >119.71pg/ml,in patients with these,although there were no typical symptoms of active tuberculosis,no abnormal imaging findings or old lesions in the lungs,the presence or absence of cavities,but it was strongly suggested that active tuberculosis may be active during the 3 months.Figure2;Table6;Reference 86... |
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