结核感染T细胞斑点试验在结核诊断中的应用  

Clinical usefulness of T SPOT. TB in the diagnosis of tuberculosis

作　　者：谢希[1] 陈进伟[1] 高洁生[1] 李芬[1] 田静[1] 杜金烽[1] 王静[1] 毛妮[1] 

机构地区：[1]中南大学湘雅二医院风湿免疫科,长沙410011

出　　处：《临床内科杂志》2010年第6期396-399,共4页Journal of Clinical Internal Medicine

摘　　要：目的 比较结核感染T细胞斑点试验（T SPOT.TB）和结核菌素试验（（TST）在结核诊断中的敏感性和特异性,探讨两者在结核感染中的诊断价值.方法 对疑患结核的90例患者进行前瞻性研究.收集患者临床资料,采用T SPOT.TB和TST试验,比较二者对结核诊断的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR＋）和阴性似然比（LR-）.结果 90例疑患结核患者确诊结核28例.T SPOT.TB实验在敏感性、特异性、PPV、NPV、准确度等方面显著优于TST（P＜0.05）;T SPOT.TB的LR＋值明显高于TST,LR-值明显低于TST.TST和TSPOT.T的一致性弱（κ＜0.4）.结论 T SPOT.TB较TST有更高敏感性和特异性,较TST更适于作为结核筛检试验,也适用于肺外结核的检测及结核的排除诊断.T SPOT.TB受免疫抑制影响小,应作为有免疫抑制危险因素患者隐匿性结核的筛查项目.Objective To compare and analyze the usefulness and diagnostic value of T SPOT and TST tests in tuberculosis diagnosis. Methods Patients with suspected tuberculosis were prospectively enrolled. T SPOT. TB and TST tests were administered in each patient and clincal data were collected. The test results were compared and analysed with final clinical diagnoses. Results 90 cases were enrolled and 28 were finally diagnosed with tuberculosis. T SPOT. TB demonstrated superiority over TST in sensitivity, speciality,PPV, NPV and accuracy （ P 〈 0.05 ）, and the concordance was poor between the TST and T SPOT （ K 〈 0.4）. Conclusion T SPOT. TB is superior to TST for screening and differential dignosis of tuberculosis, espcially extrapulmonary tuberculosis, because of its higher sensitivity and specificity. T SPOT. TB is also recommended for latent tuberculosis screening in patients with immunosuppressing risks.

关 键 词：结核 结核感染T细胞斑点试验 诊断 

分 类 号：R520.4[医药卫生—内科学]