Lee L-N, Chou C-H, Wang J-Y, Hsu H-L, Tsai T-H, Jan I-S, Hsueh P-R, Yang P-C
Department of Laboratory Medicine, National Taiwan University Collegte of Medicine, Taipei, Taiwan.
Clin Microbiol Infect. 2009 Feb;15(2):173-9. doi: 10.1111/j.1469-0691.2008.02655.x. Epub 2009 Jan 10.
Patients presenting with pleural effusion of undetermined aetiology were prospectively enrolled, and an enzyme-linked immunospot (ELISPOT) assay on pleural fluid and peripheral blood was performed. Forty patients were studied, including 19 with culture- or biopsy-confirmed (n = 15) or clinically compatible (n = 4) tuberculous pleurisy, and 21 with pleural effusions due to non-tuberculous causes. The sensitivity, specificity and positive and negative predictive values of the assay were 94.7%, 85.7%, 85.7% and 94.7%, respectively, on pleural fluid, and 77.8%, 90.5%, 87.5% and 82.6%, respectively, on blood. Antigen-specific, interferon-gamma-secreting T-cells were concentrated eight to ten times in pleural fluid as compared with blood. Among the seven patients not suitable for pleural biopsy and three patients whose biopsy results were non-diagnostic, nine had positive ELISPOT result with pleural fluid. The ELISPOT assay for interferon-gamma can accurately diagnose tuberculous pleurisy and is helpful for patients not suitable for pleural biopsy and those whose biopsy results are non-diagnostic.
对病因不明的胸腔积液患者进行前瞻性入组，并对胸水和外周血进行酶联免疫斑点（ELISPOT）检测。共研究了40例患者，其中19例经培养或活检确诊（n = 15）或临床符合（n = 4）结核性胸膜炎，21例为非结核性原因所致胸腔积液。该检测在胸水上的敏感性、特异性、阳性预测值和阴性预测值分别为94.7%、85.7%、85.7%和94.7%，在血液上分别为77.8%、90.5%、87.5%和82.6%。与血液相比，抗原特异性、分泌干扰素-γ的T细胞在胸水中浓缩了8至10倍。在7例不适合胸膜活检的患者和3例活检结果无诊断意义的患者中，9例胸水ELISPOT结果为阳性。干扰素-γ的ELISPOT检测可准确诊断结核性胸膜炎，对不适合胸膜活检的患者和活检结果无诊断意义的患者有帮助。
