Cheng Jun, Zhao Lei, Shi Tianru, Zhu Ziwen, Sham Nelson Ow, Xiao Huaping, Bai Qian, Wakefield Mark R, Ye Ying, Fang Yujiang
Clin Lab. 2019 Mar 1;65(3). doi: 10.7754/Clin.Lab.2018.180736.
Primary hepatic tuberculosis is a very rare clinical form of tuberculosis, with atypical clinical presentations and nonspecific imaging features. This results in great difficulty to reach a correct and timely clinical diagnosis. Traditionally, liver biopsy is the gold standard for its diagnosis. Here we assessed the effectiveness of using a T-SPOT.TB test in the early diagnosis of primary hepatic tuberculosis.
We report a case of primary hepatic tuberculosis whose location of hepatic lesion renders it hard to perform a biopsy. Instead, a T-SPOT.TB test was utilized to help in the early diagnosis of this rare form of tuberculosis. A conventional fourdrug regimen for anti-tubercular therapy together with vitamin B6 was initiated and maintained for 6 months.
The T-SPOT.TB test was highly positive for ESAT-6 (87 > 20) and CFP-10 (89 > 20). Dull pain in the upper right abdomen was gone 2 months post treatment. The abnormal lesions shown in an MRI reduced significantly 4 months post treatment. Spot count for ESAT-6 and CFP-10 decreased 6 months post treatment.
The results of this study suggest the critical role of T-SPOT.TB test in the earlier diagnosis of prima¬ry hepatic tuberculosis for those patients who have difficulties having a hepatic biopsy.
原发性肝结核是一种非常罕见的结核临床类型，临床表现不典型，影像学特征不特异。这导致难以做出正确及时的临床诊断。传统上，肝活检是其诊断的金标准。在此，我们评估了使用结核感染T细胞检测（T-SPOT.TB）在原发性肝结核早期诊断中的有效性。
我们报告一例原发性肝结核病例，其肝脏病变位置使得难以进行活检。取而代之的是，利用结核感染T细胞检测来帮助早期诊断这种罕见的结核类型。启动并维持了一种常规的四联抗结核治疗方案并加用维生素B6，持续6个月。
结核感染T细胞检测对早期分泌性抗原靶6（ESAT-6，87＞20）和培养滤液蛋白10（CFP-10，89＞20）呈强阳性。治疗2个月后右上腹隐痛消失。治疗4个月后磁共振成像（MRI）显示的异常病变明显缩小。治疗6个月后ESAT-6和CFP-10的斑点数减少。
本研究结果提示，对于那些难以进行肝活检的患者，结核感染T细胞检测在原发性肝结核的早期诊断中起关键作用。
