The Value Of T-SPOT.TB For Screening Tuberculosis Infection In Patients With Rheumatic Autoimmune Disease

Objective:1.To investigate the value of the enzyme-linked immunospot test(T-SPOT.TB)for the diagnosis of tuberculosis infection in patients with rheumatic diseases and the situation of the rheumatism immunity in patients with latent TB infection.2.To investigate diagnosis scheme of screening for latent TB infection in rheumatisant who before and during the process of immunosuppressive therapy.Methods:355 cases of Patients with rheumatic autoimmune disease from September 2016 to January 2015 in The first hospital of Jilin university,select 46 cases rheumatic autoimmune disease Patients with tuberculous infection,44 cases of tuberculosis patients without rheumatic autoimmune disease selected,analyze the value of Lung CT,TB-Ab,TST and T-SPOT.TB in the diagnosis of tuberculosis;Select 93 cases of patients with rheumatic autoimmune disease using immunosuppressive therapy as experimental group,the other as control group.To analysis the infection of immunosuppressive therapy and patients of rheumatic autoimmune disease with mycobacteriumtuberculosis;Immunosuppressive treatment group,93 cases of patients will be divided into three groups according to immunosuppressive therapy time,for A group of less than 6 months,Seven months and 24 months for group B,More than 25 months in group C.To investigate the correlation of immunosuppressive therapy time with TB infection and latent TB progression to active TB.Results:1.The sensitivity of T-SPOT.TB assay was 82.61%,significantly higher than TB-Ab(47.83%),The difference was statistically significant(X2=12.267,P=0.001).But The T-SPOT.TB test comparing with chest CT(71.74%),it had no statistical significance(X2=1.543,P=0.214);2.The T-SPOT.TB’s positive predictive value 、 positive predictive value、Youden index、positive likelihood ratio significantly higher than TB-Ab and chest CT(P<0.05).The T-SPOT.TB test’s positive rate and TB infection rates of Immunosupp-ression group is 37.60% and 24.70%,comparing with the control group,it had statistical significance(X2=9.52,P=0.002;X2=14.487,P<0.001),Latent TB infection’s rate of immunosuppression group’s and the control group was 7.5%,9.5%respectively,and difference between the two groups had no statistical significant(X2=0.34,P=0.56).Immunosuppressive therapy group,The group A T-SPOT.TB positiverate was 30%,group B positive rate was 37.78%,group C positive rate was 50%.A,B,C three groups of TB infection rates were 10%,26.67%and 38.89% respectively.A,B,C three groups of latent TB infection rates were 10%,8.89% and 0% respectively.Conclusion:1.The sensitivity and speciality of T-SPOT.TB in the diagnosis of tuberculosis were higher than that of TB-Ab and lung CT.2.Long-term immunosuppressive therapy in patients with rheumatic autoimmune disease has a high risk of TB infection.3.The T-SPOT.TB assay has higher value in diagnosis of rheumatisants with mycobacterium tuberculosis infection.