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研究生:葉雅雯
研究生(外文):Yea-Wen Yeh
論文名稱:新喋呤對偵測結核感染的診斷價值-類風溼性關節炎患者接受生物製劑治療期間發生QFT結果轉變
論文名稱(外文):Diagnostic value of neopterin for detecting tuberculosis in rheumatoid arthritis patients with QuantiFERON conversion during biologic therapy
指導教授:林季千
口試委員:陳得源林民昆
口試日期:2015-07-28
學位類別:碩士
校院名稱:國立中興大學
系所名稱:生命科學院碩士在職專班
學門:生命科學學門
學類:生物學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:44
中文關鍵詞:新喋呤結核感染生物製劑類風濕性關節炎結核菌感染診斷試管組
外文關鍵詞:neopterintuberculosis (TB)biologicsrheumatoid arthritis (RA)QuantiFERON-TB-Gold In Tube (QFT-GIT)
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Frequent QuantiFERON-TB-Gold In Tube (QFT-GIT) conversion was observed in rheumatoid arthritis (RA) patients receiving biologic therapy. We aimed to evaluate the diagnostic utility of plasma cytokines and chemokines for identifying active tuberculosis (TB) in RA patients with QFT conversion.
We prospectively evaluated 187 patients who received biologic therapy and serial QFT-GIT assays. QFT-GIT was performed by measuring IFN-γ levels in whole blood treated with TB-specific antigens. Levels of TB-related cytokines and chemokines at the time of QFT-GIT assays were determined by multiplex assay using the Milliplex MAP Human Cytokine/ Chemokine Panel and enzyme-linked immunosorbent assay.
QFT conversion was observed in 54 (28.9%) of 187 RA patients, 54 RA patients with QFT conversion at baseline, 7 patients developed active TB (RA-TB) during the period of biologic therapy. Neopterin levels assessed at the time of active TB were higher in RA-TB patients than in RA non-TB subjects. The optimal cut-off neopterin level for detecting active TB using ROC curve analysis was 5045 pg/ml.
RA patients with QFT conversion during the period of biologic therapy should be carefully evaluated and stimulated levels (TB-specific antigens) of neopterin may provide an useful information for identifying active TB.

中文摘要 i
英文摘要 ii
目次 iii
圖表目次 iv
第一章 前言 1
ㄧ、 簡介 1
二、 結核感染(Tuberculosis Infection) 2
三、 類風濕性關節炎(Rheumatoid arthritis, RA) 4
四、 類風濕性關節炎患者使用生物製劑與活動性結核關聯 7
五、 有鑑別潛力的生物因子(Biomarker) 8
六、 關於QFT conversion定義 8
七、 研究目的 9
第二章 材料及方法 11
ㄧ、 研究對象 11
二、 檢體收集處理 12
三、 實驗方法 12
第三章 結果 18
ㄧ、 研究族群基本資料 18
二、 有QFT conversion現象且發展成活動性結核(RA-TB) 18
三、 各項細胞激素及趨化因子表現 19
四、 Neopterin測定值與RA疾病活動性(DAS28)的相關性 20
五、 Neopterin對偵測活動性結核的診斷價值 20
第四章 討論 21
一、 探討QFT-GIT偵測、診斷的能力 21
二、 細胞激素及趨化因子的表現 23
三、 Neopterin的表現 24
第五章 參考資料 26
表一、 結核菌感染診斷試管組(QFT-GIT)結果判讀標準 34
表二、 研究族群基本資料 35
表三、 細胞激素、趨化因子的表現(TB-specific Ag, Mitogen-Stimulated) 36
圖一、 使用生物製劑結核菌篩選試驗流程 37
圖二、 實驗篩選流程圖 39
圖三、 細胞激素、趨化因子的表現(TB-specific Ag, Mitogen-Stimulated) 42
圖四、 實驗起點與終點細胞激素、趨化因子的表現(TB-specific Ag) 43
圖五、 利用ROC找出最佳Cut-off值 44


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