结核感染T细胞斑点试验与ADA活性检测对结核性胸腔积液的诊断评价  

Value of T cell spot test of tuberculosis infection and ADA activity assay in diagnosis of tuberculous pleural effusion

作　　者：余碧芸[1] 周莹艳[1] 邵川[1] 孙琦[2] 朱育银[3] 高国生[4] 祝成亮[5] 

机构地区：[1]宁波市医疗中心李惠利医院呼吸内科,浙江宁波315040 [2]宁波市医疗中心李惠利医院检验科,浙江宁波315040 [3]宁波市第二医院医院肺科,浙江宁波315010 [4]宁波市第二医院医院检验科,浙江宁波315010 [5]武汉大学人民医院检验科,湖北武汉430060

出　　处：《中华医院感染学杂志》2016年第10期2235-2238,共4页Chinese Journal of Nosocomiology

基　　金：国家973计划基金资助项目(2012CB518900);宁波市科技富民惠民基金资助项目(2015C50021)

摘　　要：目的探讨外周血结核感染T细胞斑点试验(T-SPOT.TB)和胸水腺苷脱氨酶(ADA)活性检测在结核性胸腔积液诊断中的临床应用评价,以有效提高特异性。方法收集2013年11月-2015年3月受试者117例,其中结核性胸腔积液组51例,非结核性胸腔积液组66例,行外周血T-SPOT.TB试验和胸水ADA活性检测,对检测结果进行统计分析。结果结核性胸腔积液组的外周血T-SPOT.TB和胸腔积液ADA的阳性率分别为90.20%和54.90%,显著高于非结核性胸腔积液组的16.67%和13.64%(P<0.01);结核性胸腔积液组的外周血T-SPOT.TB的A、B孔斑点形成细胞数和胸腔积液ADA活性均显著高于非结核组(P<0.01);A、B孔斑点形成细胞数诊断结核性胸腔积液的ROC曲线下面积均>0.900,敏感性和特异性分别为98.00%和74.20%,而ADA的ROC曲线下面积为0.851,敏感性和特异性分别为92.20%和81.80%;结核组和非结核组的外周血T-SPOT.TB和胸腔积液ADA检测结果之间存在互补性。结论外周血T-SPOT.TB检测诊断结核性胸腔积液有较好的临床应用价值,但特异性稍差,联合胸水ADA活性检测可提高诊断的准确性。OBJECTIVE To explore the clinical value of peripheral blood T cell spot test of tuberculosis infection（TSPOT.TB）assay and pleural effusion adenosine deaminase（ADA）activity assay in diagnosis of tuberculous pleural effusion so as to improve the specificity.METHODS A total of 117 subjects were enrolled in the study from Nov2013 to Mar 2015 and divided into the tuberculous pleural effusion group with 51 cases and the non-tuberculous pleural effusion group with 66 cases.The subjects received the peripheral blood T-SPOT.TB assay and pleural effusion ADA activity assay,and the detection results were statistically analyzed.RESULTS The positive rate of the peripheral blood T-SPOT.TB assay of the tuberculous pleural effusion group was 90.20%,significantly higher than 16.67% of the non-tuberculous pleural effusion group;the positive rate of the pleural effusion ADA assay of the tuberculous pleural effusion group was 54.90%,significantly higher than 13.64% of the non-tuberculous pleural effusion group（P〈0.01）.The A,B panel forming cell counts of peripheral blood T-SPOT.TB assay and pleural effusion ADA activity were significantly higher in the tuberculous pleural effusion group than in the non-tuberculous pleural effusion group（P〈0.01）.The area under ROC curve of the A,B panel forming cell counts was more than 0.900 in the diagnosis of tuberculous pleural effusion,and the sensitivity and specificity were 98.00%and 74.20%,respectively.The area under ROC curve of the ADA was 0.851,the sensitivity and specificity were92.20% and 81.80%,respectively.The peripheral blood T-SPOT.TB assay was complementary to the pleural effusion ADA assay.CONCLUSIONThe peripheral blood T-SPOT.TB assay has great clinical value in diagnosis of tuberculous pleural effusion,but the specificity is limited;the accuracy of diagnosis can be improved when in combination with pleural effusion ADA activity assay.

关 键 词：结核 胸膜 胸腔积液 腺苷脱氨酶 结核感染T细胞斑点试验 干扰素释放试验 

分 类 号：R446.5[医药卫生—诊断学]