γ-干扰素释放试验检测胸腔积液对诊断结核性胸膜炎的初步探讨  

Comparison of interferon-gamma release assays and adenosine deaminase of pleural fluid for the diagnosis of pleural tuberculosis

作　　者：刘菲[1] 张霞[1] 杜凤娇[1] 潘丽萍[1] 刘洋[1] 贾红彦[1] 邢爱英[1] 杜博平 孙琦[1] 古淑香[1] 张宗德[1] 

机构地区：[1]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所耐药结核病北京市重点实验室,101149

出　　处：《中华结核和呼吸杂志》2014年第5期323-327,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：基金项目：国家科技重大专项课题（2012ZX10003002）;首都医学发展科研基金（2009-3146）

摘　　要：目的通过比较胸腔积液的结核感染T细胞斑点试验（T—SPOT．TB）和腺苷脱氨酶（ADA）等常规检测，评价T—SPOT．TB在结核性胸膜炎诊断中的价值。方法将2011年6月至2012年11月在北京胸科医院住院的胸腔积液患者（除外诊断不明确和临床诊断结核性胸膜炎病例）111例，分为确诊结核性胸膜炎组（59例）和非结核性胸膜炎组（52例）。对所有患者的胸腔积液进行T-SPOT．TB和ADA检测。两组T-SPOT．TB的斑点形成细胞（SFC）数量比较采用Mann-Whitney U检验，两种检测方法诊断结核性胸膜炎的敏感度和特异度比较采用X2检验。结果根据两组胸腔积液T-SPOT．TB检测的SFC数确定T—SPOT．TB诊断结核性胸膜炎的界值为216／10^6胸腔积液单个核细胞。T—SPOT．TB诊断结核性胸膜炎的敏感度（91．5％，54／59）显著高于ADA（71．2％，42／59），差异有统计学意义（x2=8．045，P〈0．01）；T—SPOT．TB诊断结核性胸膜炎的特异度（90．4％，47／52）与ADA（92．0％，46／50）的差异无统计学意义（0=0．000，P〉0．05）。胸腔积液T—SPOT．TB和ADA检测的受试者工作特征曲线下面积分别为0．912和0．903。两种方法联合检测胸腔积液的敏感度降至67，8％（40／59），但特异度升至100．0％（50／50）。结论T—SPOT．TB检测胸腔积液是较准确的辅助诊断结核性胸膜炎的方法，与ADA联合检测可显著提高诊断的特异度。Objective To compare the diagnostic performance of interferon gamma releasing assays （T-SPOT. TB） and adenosine deaminase （ADA） in pleural tuberculosis, and therefore to evaluate the value of T-SPOT. TB in a high tuberculosis burden country. Methods From June 2011 to November 2012,111 patients with pleural fluid in Beijing Chest Hospital, Capital Medical University were enrolled prospectively and categorized as culture/biopsy-confirmed pleural tuberculosis group （ n = 59） and non-pleural tuberculosis group （n = 52）. Patients with uncertain diagnosis and clinically diagnosed pleura/tuberculosis were excluded from the study. Pleura1 fluid T-SPOT. TB and ADA measurements were performed,in addition to other routine laboratory tests. Continuous variables （spot forming cells, SFCs） were compared using nonparametric Mann- Whitney U test. Comparisons between proportions were performed using Chi-squared test. Results The receiver operating characteristic （ROC） curve and cut-off value of pleural fluid T-SPOT. TB were established according to spot forming cells （SFC） between culture/biopsy-confirmed pleural tuberculosis group and non-pleural tuberculosis group （216 SFC/106 pleural fluid mononuclear cells）. The sensitivity of pleural fluid T-SPOT. TB and ADA was 91.5% （54/59） and 71.2% （42/59） ,respectively. The specificity was 90.4% （47/52） and 92. 0% （46/50）, respectively. The sensitivity of pleural fluid T-SPOT. TB was significantly higher than that of ADA （X2 = 8. 045 ,P 〈 0. 01 ）. There was no significant difference of specificity between pleural fluid T-SPOT. TB and ADA （x2 =0. 000,P 〉0. 05）. The area under the ROC curve was 0. 912 for pleural fluid T-SPOT. TB and 0. 903 for ADA. The sensitivity of combination diagnosis of ADA and pleural fluid T-SPOT. TB decreased to 67.8% （ 40/59 ）, but the specificity increased to 100. 0% （ 50/50 ）. Conclusions Pleural fluid T-SPOT. TB are relatively accurate supplementary assays for the diagnosis of pleural tubercu

关 键 词：结核 胸膜 胸腔积液 腺苷脱氨酶 Γ-干扰素释放试验 

分 类 号：R521.7[医药卫生—内科学]