γ-干扰素释放试验对不同年龄组疑似肺结核的辅助诊断价值  

Evaluation of T-SPOT.TB Assay in the Diagnosis of Pulmonary Tuberculosis within Different Age Groups

作　　者：潘丽萍[1] 贾红彦[1] 刘菲[1] 高孟秋[1] 孙会姗 杜博平 孙琦[1] 邢爱英[1] 魏荣荣[1] 张宗德[1] 

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

出　　处：《结核病与胸部肿瘤》2016年第1期1-5,共5页Tuberculosis and Thoracic Tumor

基　　金：“十二五”国家科技重大专项（2015ZX10004801--003）;北京市医院管理局临床医学发展专项（ZYLX201304）;重大传染病防治协同创新中心（PXM2015014226_000058）;北京市优秀人才培养项目（2013D003034000038）

摘　　要：目的探讨结核感染T细胞斑点试验（T-SPOT．TB）对不同年龄疑似肺结核病例的辅助诊断价值。方法回顾性分析2012年11月至2014年2月首都医科大学附属北京胸科医院收治的疑似肺结核病例1518例，所有病例均无结核病史，并在抗结核治疗前行T-SPOT．TB检测。根据诊断结果分为肺结核确诊组599例，男388例，女211例，年龄16～89岁；非结核组235例，男144例，女91例，年龄14～85岁，剔除其余诊断不明和临床诊断肺结核病例684例。按照年龄将纳入人群分为中青年组536例（14～59岁）和老年组298例（60～89岁）。将T-SPOT．TB结果与诊断结果进行比较，分析T-SPOT．TB的诊断效能。组间样本率比较采用χ^2检验，组间非正态分布计量资料比较采用Mann-Whitney U检验。结果T-SPOT．TB诊断的敏感度为90．1％（540／599），特异度为65．5％（154／235），阳性预测值为86．9％（540／621），阴性预测值为72．3％（154／213），阳性似然比为2．61，阴性似然比为0．15。中青年组T-SPOT．TB诊断的敏感度和特异度为92．6％（375／405）和75．6％（99／131），老年组T-SPOT．TB诊断的敏感度和特异度为85．0％（165／194）和52．9％（55／104），前者的诊断敏感度和特异度均显著高于后者（P〈0．01），且外周血单个核细胞（PBMC）斑点形成数显著高于后者[300个（128666个）／10^6PBMCs，258个（79621个）／10^6PBMCs，P=0．037]。结论T-SPOT．TB对中青年肺结核有较好的辅助诊断价值，但对老年肺结核的诊断性能相对较低。Objective To evaluate the value of T-SPOT.TB assay in the diagnosis of pulmonary tuberculosis within different age groups. Methods We analyzed 1518 suspected pulmonary tuberculosis （PTB） patients who were admitted to the Beijing Chest Hospital from November 2012 to February 2014 and had valid T-SPOT.TB tests before anti-tuberculosis therapy. The 599 microbiologically and/or histopathologically-confirmed PTB patients （16-89 years old, 388 males and 211 females） and 235 non-TB patients （14-85 years old, 144 males and 91 females） were enrolled for the analysis of diagnostic performance of T-SPOT.TB, while patients with uncertain diagnosis or diagnosis based on clinical impression （n=684） were excluded from the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB were analyzed according to the final diagnosis. Furthermore, the diagnostic performance of T-SPOT.TB assay in the younger patients （14- 59 years old） and elderly patients （60-89 years old） were also analyzed respectively. Categorical variables were compared by Pearson＇s Chi-square test, while continuous variables were compared by the Mann-Whitney U-test. Results The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB in diagnosis of PTB were 90.1% （540/599）, 65.5% （154/235）, 86.9% （540/621）, 72.3% （154/213）, 2.61, and 0.15, respectively. The sensitivity and specificity of T-SPOT.TB assay were 92.6% （375/405） and 75.6% （99/131）, respectively in the younger patients, and 85.0% （165/194）, 52.9% （55/104） respectively in the elderly patients. The sensitivity and specificity ofT-SPOT. TB assay in the younger patients were significantly higher than those in the elderly patients （P〈0.01）, and the spot forming cells in the younger PTB patients were significantly higher than in the elderly PT

关 键 词：结核 肺 干扰素Γ 酶联免疫斑点检测 

分 类 号：R521[医药卫生—内科学]