三种胸腔积液检测方法对结核性胸膜炎诊断价值的研究  

Diagnostic Value of Three Kinds of Pleural Effusion Detection Methods for Pleural Tuberculosis

作　　者：李雪莲[1] 陈红梅[1] 张立群[1] 马丽萍[1] 吴晓光[1] 高孟秋[1] Li Xuelian;Chen Hongmei;Zhang Liqun;Ma Liping;Wu Xiaoguang;Gao Mengqiu(Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核科,101149

出　　处：《结核病与胸部肿瘤》2018年第2期109-113,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的比较胸腔积液腺苷脱氨酶（adenosine deamianse，ADA）、结核感染T细胞斑点试验（T-SPOT．TB）和结核分枝杆菌／利福平耐药基因检测（Xpert MTB／RIF）在结核性胸膜炎诊断中的价值。方法回顾性分析140例胸膜炎患者的临床资料，其中结核性胸膜炎患者90例，非结核性胸膜炎患者50例，两组患者均抽取胸腔积液送检ADA、T-SPOT．TB和Xpert MTB／RIF检测，比较两组患者的检测结果。结果结核性胸膜炎患者胸腔积液ADA为（45．3±22．6）U／L，明显高于非结核性胸膜炎患者（23．2±23）U／L，差异有显著性（t=3．893，P=0．000），ADA诊断结核性胸膜炎的敏感度、特异度分别为71．1％和84％。结核性胸膜炎和非结核性胸膜炎患者胸腔积液T-SPOT．TB的中位数分别为1000SFCs（931，1000）和32SFCs（4，200），两组比较差异有显著性（U=126．0，P=0．000），其诊断结核性胸膜炎的敏感度、特异度分别为84．4％和96％。胸腔积液Xpert MTB／RIF诊断结核性胸膜炎的敏感度、特异度分别为13．3％和100％。胸腔积液ADA、胸腔积液T-SPOT．TB的敏感度均明显高于胸腔积液Xpert MTB／RIF（χ^2=30．789，P=0．000；χ^2=45．534，P=0．000）。胸腔积液ADA和胸腔积液T-SPOT．TB的敏感度差异无显著性（χ^2=2．314，P=0．204）。三种检测方法的特异度差异均无显著性。结论胸腔积液T-SPOT．TB和ADA诊断结核性胸膜炎具有较高的敏感度和特异度，而Xpert MTB／RIF对胸腔积液标本的诊断价值则较低。胸腔积液T-SPOT．TB和ADA二者联合检测可以提高结核性胸膜炎诊断的敏感度。Objective This research investigated to evaluate the performance of ADA, T-SPOT.TB and Xpert Mtb/RIF assay in plenral fluid （PF） for diagnosis of pleural tuberculosis （PTB）. Method A total of 140 patients were enrolled in this research. 90 cases were diagnosed as PTB, 50 cases were Non-PTB patients. ADA, T-SPOT.TB and Xpert Mtb/RIF in PF were tested in both groups. Result PF ADA in PTB patients was （45.3 ± 22.6） U/ L, which was significantly higher than that in non-PTB group [（23.2 ± 23） U/L, （t=3.893, P=0.000）]. The sensitivity and specificity of diagnosis of PTB were 71.1% and 84%, respectively. The median PF T-SPOT.TB was 1000 SFCs （931, 1000） and 32 SFCs （4,200） in patients with PTB and non-PTB, respectively. There was a significant difference between the two groups （U=126.0, P=0.000）. The sensitivity and specificity for the diagnosis of PTB were 84.4% and 96%. The sensitivity and specificity of PF Xpert Mtb/RIF for diagnosis of PTB were 13.3% and 100%. The sensitivity of PF ADA and T-SPOT.TB were significantly higher than that of PF Xpert Mtb/RIF （χ^2=30.789, P=0.000;χ^2=45-534, P=0.000）. There was no significant difference in the sensitivity of PF ADA and T-SPOT. TB （ χ^2=2.314, P=0.204）. There was no significant difference in the specificity of the three detection methods. Conclusion PF T-SPOT.TB and ADA test had a high sensitivity and specificity for the diagnosis of PTB, while Xpert Mtb/RIF test has a lower diagnostic value for PF specimens. The combined detection of PF T-SPOT.TB and ADA can improve the diagnostic sensitivity of PTB.

关 键 词：腺苷脱氨酶 Γ-干扰素 基因Xpert检测 诊断 结核性胸膜炎 

分 类 号：R521.7[医药卫生—内科学]