胸腔镜胸膜活检联合外周血T-spot-TB试验对结核性胸膜炎的诊断价值分析  

Diagnostic value of thoracoscopic pleural biopsy joint peripheral blood T-SPOT-TB on tuberculous pleurisy

作　　者：高俊峰[1] 张齐武[1] 

机构地区：[1]解放军第210医院呼吸内科,辽宁大连116021

出　　处：《临床肺科杂志》2017年第2期244-247,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析胸腔镜胸膜活检联合外周血T-SPOT-TB试验对结核性胸膜炎的诊断价值。方法2012年2月-2015年4月解放军第210医院呼吸内科就诊的疑似结核性胸膜炎患者98例,根据《肺结核诊断和治疗指南》确诊为结核性胸膜炎患者60例,非结核性胸膜炎患者38例。98例患者先后行胸腔镜胸膜活检和外周血T-SPOT-TB试验,比较单独行T-SPOT-TB试验检查和联合检查的准确性。结果(1)60例已确诊为结核性胸膜炎的患者经单独T-SPOT-TB试验检查和联合检查,联合检查的敏感度为93.33%,高于单独T-SPOT-TB试验检查80.00%和单独胸腔镜胸膜活检60.00%,两者差异均有显著性(P<0.05)。(2)38例确诊为非结核性胸膜炎的患者分别经单独T-SPOT-TB试验检查和联合检查,联合检查的特异度为97.37%,明显高于单独T-SPOT-TB试验检查81.58%和单独胸腔镜胸膜活检65.79%,两者差异均有显著性(P<0.05)。(3)联合检查的阳性预测值为98.24%,明显高于单独T-SPOT-TB试验检查87.27%和单独胸腔镜胸膜活检73.47%,两者差异有显著性(P<0.05)。(4)联合检查的阴性预测值为90.24%,明显高于单独T-SPOT-TB试验检查72.09%和单独胸腔镜胸膜活检51.02%,两者差异有显著性(P<0.05)。(5)联合检查的诊断率为94.90%,明显高于单独T-SPOT-TB试验检查80.61%和单独胸腔镜胸膜活检62.24%,两者差异有显著性(P<0.05)。结论胸腔镜胸膜活检联合外周血结核感染T细胞体外释放酶链免疫试验的敏感度、特异度、阳性预测值、阴性预测值和诊断率均高于单独应用外周血结核感染T细胞体外释放酶链免疫试验,联合检验对结核性胸膜炎有较高的诊断价值。Objective To analyze the diagnostic value of thoracoscopic pleural biopsy joint peripheral blood T-SPOT-TB on tuberculous pleurisy. Methods 98 cases suspected with tuberculous pleurisy from February 2012 to April 2015 were enrolled, and 60 cases were confirmed with tuberculous pleurisy and 38 cases with non-tuberculous pleurisy by Pulmonary Tuberculosis Diagnosis and Treatment Guidance. 98 patients underwent thoracoscopic pleural biopsy and peripheral blood T-SPOT-TB test to compare the accuracy of a separate line T-SPOT-TB test and joint inspections. Results （1） 60 patients with tuberculous pleurisy received a single T-SPOT-TB test and joint inspec- tion. The sensitivity of joint inspection was 93.33% , higher than the single T-SPOT-TB test （80. 00% ） and thoraeoscopie pleura] biopsy （60.00%） （P 〈 0. 05 ）. （2）38 patients with non-tuberculous pleurisy received a single T- SPOT-TB test and joint inspection. The specificity of joint inspection was 97. 37% , significantly higher than single T- SPOT-TB test （81.58 % ） and thoracoscopic pleura] biopsy （65.79 % ） （P 〈 0.05 ）. （3） The positive predictive value of joint inspection was 98.24% , significantly higher than single T-SPOT-TB test （87.27%） and thoracoscopic pleu- ra] biopsy （73.47%） （P 〈 0. 05 ）. （4） The negative predictive value of joint inspection was 90. 24% , significantly higher than single T-SPOT-TB （72. 09% ） and thoracoscopic pleura] biopsy （51.02%） （P 〈0. 05）. （5） The diagnosis rate of joint inspection was 94. 90% , significantly higher than single T-SPOT-TB （80. 61% ） and thoracoscopic pleural biopsy （62. 24% ） （P 〈 0. 05）. Conclusion The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic rate of thoracoscopic pleura] biopsy joint peripheral blood T-SPOT-TB are all higher than peripheral blood T-SPOT-TB, which means the joint inspection of tuberculous pleurisy has high diagnostic value.

关 键 词：胸腔镜胸膜活检 外周血 T—SPOT—TB试验 结核性胸膜炎 

分 类 号：R521.7[医药卫生—内科学]