结核诊断指标在诊断肺结核中的临床意义  

Clinical significance of tuberculosis indicators in diagnosis of pulmonary tuberculosis

作　　者：战云飞[1] 刘风霞[1] 杨效光 刘国利[1] 吴海良[1] 李欣欣[1] 李淑艳[1] 

机构地区：[1]山东省胸科医院结核内一科,山东济南250013

出　　处：《中华医院感染学杂志》2013年第21期5369-5371,共3页Chinese Journal of Nosocomiology

摘　　要：目的调查血结核抗体、结核菌素试验(PPD试验)、胸部CT、血沉4种指标对诊断肺结核的临床意义。方法随机选取2010年1月-2010年6月住院的肺结核患者(PTB)160例和非结核患者(NPTB)100例,对其血结核抗体、PPD试验、胸部CT、血沉进行统计分析,血结核抗体采用ELISA法测定,PPD试验采用卡介菌纯蛋白衍生物(BCG-PPD),统计比较采用χ2检验,应用SPSS11.0软件进行统计分析。结果血结核抗体敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)分别为37.5%、68.0%、65.2%、59.5%;PPD试验硬结平均直径≥5、≥10、≥15、≥20 mm的敏感性、特异性、PPV、NPV分别为88.8%、86.8%、76.9%、61.3%,20.0%、22.0%、86.0%、90.0%,64.0%、64.1%、89.8%、90.7%,52.7%、78.8%、27.5%、13.9%;肺结核胸部CT表现阳性率为97.5%;血沉率65.0%;当PPD硬结平均直径≥15mm或≥20mm时诊断肺结核的敏感性、特异性、NPV和PPV均高于血结核抗体,比较差异有统计学意义(P<0.01)。结论 PPD试验较血结核抗体对诊断肺结核的意义大,胸部CT阳性率高于血沉,诊断肺结核优先选择胸部CT和PPD试验。OBJECTIVE To investigate the clinical significance of four diagnostic indicators including the blood tuberculosis antibody, tuberculin （PPD）test, chest CT ,and erythrocyte sedimentation rate （ESR） in diagnosis of pulmonary tuberculosis （PTB）. METHODS A total of 160 cases of PTB patients and 100 cases of non-pulmonary tuberculosis （NPTB） patients who were treated in the hospital from Jan 2010 to Jul 2010 were enrolled in the study, then the blood TB-Ab, PPD test, chest CT, and ESR of the subjects were statistically analyzed, the blood TB-Ab was determined with the use of ELISA method, the PPD test was performed by using （BCG-PPD, ehisquare test was carried out for the statistics processing, and the statistical analysis was performed with the use of SPSS11. 0 software. RESULTS The sensitivity, specificity, PPV, NPV of blood TB-Ab and the mean induration diameter of PPD test defined as more than 5mm, more than 10mm, more than 15mm, and more than 20mm were 37.5%,68.0%,65.2%,59.5%; 88.8%, 86.8%,76.9%, 61.3%;20.0%,22.0%,86.0%,90.0%; 64.0%, 64.1%, 89.8%, 90.7 %; and 52.7 %,78.8%, 27. 5%, 13.9 %. Typical tuberculous image of chest CT was defined as the positive, untypical tuberculous image of chest CT as the negative , the positive rate was 97.5 % ; the higher value of ESR was defined as the positive, normal value of ESR as negative, thee positive rate of ESR in PTB was 65.0% ; the sensitivity,specificity,PPV,and NPV of the PPD test with mean induration diameter more than 15mm or 20mm were higher than those of the blood TB-Ab in the diagnosis of PTB, the differences were significant（P〈0.01）; the positive rate of chest CT was higher than that of the ESR, the difference was signilicant（P〈0.01）. CONCLUSION The PPD test has greater significance than the blood TB-Ab in the diagnosis of PTB, the positive rate of chest CT is higher than that of the ESR in the diagnosis of PTB; the PPD test and chest CT should be the prior choice for the diagnosis of PTB.

关 键 词：血结核抗体 结核菌素试验 血沉 胸部CT 肺结核 

分 类 号：R446[医药卫生—诊断学]