学术
摘 要:
目的探讨结核分枝杆菌（MTB）多抗原蛋白芯片对儿童结核病的诊断价值。方法选取2005年4月至2006年4月在首都医科大学附属北京儿童医院诊断为结核病的住院患儿作为结核病组。选取同期住院，患感染性疾病，同时除外结核病的患儿作为非结核病组；选取体检纯化蛋白衍生物（PPD）试验阳性，既往无结核病史，无明显结核中毒症状，胸部影像学及腹部B超检查未见结核病灶的儿童作为结核感染组；选取同期行健康体检，卡疤试验阳性，无基础疾病，无结核接触史的儿童为健康对照组。各组留取血清标本。计算结核病组PPD试验阳性率及细菌学检查阳性率。应用MTB多抗原蛋白芯片同时检测标本中脂阿拉伯甘露糖（LAM）、相对分子质量16000和38000蛋白IgG抗体，通过蛋白芯片阅读仪判断结果，其中任意1种或1种以上抗体检测阳性，即判为蛋白芯片检测阳性。分别计算各组抗体检测阳性率，并计算该方法检测儿童结核病的灵敏度、特异度、阳性预测值和阴性预测值等指标。应用Logistic回归及，检验分析蛋白芯片检测阳性率与患儿年龄、病程、抗结核治疗时间、激素使用以及结核病类型的关系。结果研究期间共纳入结核病组79例，非结核病组33例，结核感染组15例，健康对照组30例。蛋白芯片检测结核病组的阳性率为34．2％（27／79），低于PPD试验阳性率（84．8％，67／79），高于细菌学检查阳性率（12．7％，10／79）。在非结核病组阳性率为6．1％（2／33），结核感染组和健康对照组阳性率为0。蛋白芯片检测结核病组的灵敏度为34．2％，特异度为97．4％。阳性预测值93．1％，阴性预测值58．5％。Logistic回归发现蛋白芯片检测阳性率仅与病程相关，且随病程延长而阳性率升高。病程〈1个月，蛋白芯片检测阳性率为18．8％（6／32），病程在～3个月，蛋白芯片检测阳性率为21．6％（8／37），病程〉3个月，蛋白芯片检测阳性率为100％（13／13）。目前的统计结果尚未发现蛋白芯片检测阳性率与患儿年龄、抗结核治疗时间、激素使用情况有显著相关关系。结核病分型不同所造成的蛋白芯片检测阳性率的差异主要是由于其病程分布不同所致。结论MTB多抗原蛋白芯片对儿童结核病的诊断有一定价值，可作为一种诊断补充手段。但该方法灵敏度较低，不适用于早期诊断。[著者文摘]
文章出处:
《中国循证儿科杂志》-2008年1期 -9-14页
栏目信息:
分 类 号:
文章编号:
1673-5501（2008）01-0009-06
相关文章:
Evaluation of diagnostic value of mycobacterium tuberculosis multiple antigen protein chip on childhood tuberculosis
ZHANG Jin, ZHAO Shun-ying, CHI Wei, JIANG Zai-fang （ Department of Internal Medicine, the Affiliated Beijing Children＇ s Hospital, Capital University of Medicine, Beijing 100045, China）
Abstract:
Objective To evaluate the diagnostic value of Mycobacterium tuberculosis （ M. tb） multiple antigen protein-chip on childhood tuberculosis. Methods Serum samples were collected from 79 cases of childhood tuberculosis patients, 33 cases of non-tuberculosis patients, 15 children with latent tuberculosis infection and 30 healthy children. Positive rate of PPD skin test and bacteriological examination in tuberculosis patient group were calculated. Mycobacterium tuberculosis multiple antigen protein-chips were used to detect three antibodies to lipoarabinomannan （LAM）, recombinant Mrl6 000and Mr 38 000 antigens simultaneously in all groups. The results were adjusted by the Protein Chip Reader equipment. If any of the three antibodies or more than one showed positive, then the result could be determinded as positive. The positive rates of protein-chip method in different groups were calculated and the sensitivity, specificity, positive predictive value, negative predictive value of the protein-chip were also calculated . The relationships among the positive rate of protein-chip and the age of patient, duration of illness, duration of anti- tuberculosis treatment , administration of corticosteroids and type of tuberculosis were analyzed by Logistic regression and X2 test. Results The positive rate of M. tb multiple antigen protein-chip was 34.2% in childhood tuberculosis, which was lower than that of PPD skin test （ 84.8% ） and higher than that of bacteriological examination（ 12.7% ）. In the non-tuberculosis patient group, the positive rate was 6.1%, in the latent tuberculosis infection group it was 0, and 0 in the healthy control group respectively. The false negative rate of the control group was 2.6%. The sensitivity, specificity detected by protein chip were 34.2%, 97.4% respectively. Positive predictive value was 93.1%, negative predictive value was 58.5%. The positive rate of protein-chip method was related to duration of illness by Logistic regression, it was 18.9% （6/32）when the illness duration 〈 1 month, 21.6% （8/37） when the illness duration between 1 and 3 month, and 100% （13/13） in those whose illness duration was longer than 3 months. Current statistical data showed there was no significant correlation between testing positive results and factors such as ages, anti-TB treatment duration, eorticosteriods administration and type of turbereulosis. The differences of the positive rate of chip testing in different TB types might be related to the differences of the illness durations in different TB types. Conclusions The Mycobacterium tuberculosis multiple antigen protein-chip method might be a supplementary way in diagnosing childhood tubercuiosis. But the sensitivity was low, and not suitable for early diagnosis.[著者文摘]
Key words:
Childhood; Tuberculosis; Serodiagnosis; Multiple antigen protein-chip
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