结核感染T细胞斑点试验在结核性浆膜炎中的诊断价值研究  

Value of T-SPOT.TB in diagnosis of tuberculous serositis

作　　者：傅满姣[1] 吴佳玲[1] 贝承丽[1] 翟安[1] 杨芬[1] 王慧[1] 曹士鹏 叶江英 Man-jiao Fu;Jia-ling Wu;Cheng-li Bei;An Zhai;Fen Yang;Hui Wang;Shi-peng Cao;Jiang-ying Ye(Changsha Central Hospital,Changsha,Hunan 410004,China)

机构地区：[1]湖南省长沙市中心医院,湖南长沙410004

出　　处：《中国现代医学杂志》2018年第29期53-57,共5页China Journal of Modern Medicine

基　　金：国家卫生和计划生育委员会传染病科技重大专项(No:2013ZX10005004)

摘　　要：目的探讨浆膜腔积液结核感染T细胞斑点试验(T-SPOT.TB)检测在结核性浆膜炎诊断中的价值。方法选取2014年8月-2016年3月于湖南省长沙市中心医院住院的152例可疑结核性浆膜炎患者,按最终诊断分为结核组和非结核组,两组行浆膜腔积液的腺苷脱氨酶(ADA)、结核分枝杆菌培养、T-SPOT.TB及结核杆菌脱氧核糖核酸检测(TB-DNA),比较4种方法在结核性浆膜炎诊断中的敏感性、特异性、阳性预测值及阴性预测值。结果患者T-SPOT.TB、ADA、TB-DNA及结核分枝杆菌培养的敏感性分别为88.2%、45.2%、9.8%和18.6%,特异性分别为86.0%、80.0%、98.0%和100.0%,阳性预测值分别为92.8%、82.1%、90.9%和100.0%,阴性预测值分别为78.2%、41.7%、34.8%和37.6%。T-SPOT.TB诊断结核性胸膜炎、结核性腹膜炎及结核性心包炎的敏感性比较,差异有统计学意义(P <0.05),T-SPOT.TB与ADA、TBDNA、结核分枝杆菌培养的敏感性和特异性比较,差异有统计学意义(P <0.05),T-SPOT.TB检测ROC曲线面积为0.893(59%CI:0.834,0.952)。结论浆膜腔积液T-SPOT.TB检测比ADA、TB-DNA、结核分枝杆菌培养更适用于诊断结核性浆膜炎。Objective To investigate the value of T-SPOT.TB detection in clinical diagnosis of tuberculous serositis.Methods A total of 152 patients of suspected tuberculous serositis in our hospital from August 2014 to March 2016 were recruited in the present study.They were divided into TB group(102 patients)and non-TB group(50 patients)according to the final diagnosis.Adenosine deaminase(ADA),Mycobacterium tuberculosis DNA(TBDNA)and T-SPOT.TB of the effusion were detected,and Mycobacterium tuberculosis(TB)culture was made.The sensitivity,specificity,positive predictive value and negative predictive value of the 4 methods for the diagnosis of tuberculous serositis were compared in the two groups.Results Regarding the four methods of T-SPOT.TB,ADA,TB-DNA and TB culture,the sensitivity was 88.2%,45.2%,9.8%and 18.6%respectively,the specificity was 86.0%,80.0%,98.0%and 100.0%respectively,the positive predictive value was 92.8%,82.1%,90.9%and 100.0%respectively,and the negative predictive value was 78.2%,41.7%,34.8%and 37.6%respectively.The sensitivity of T-SPOT.TB was different in the diagnosis of tuberculous pleurisy,tuberculous peritonitis and tuberculous pericarditis(P<0.05);when the sensitivity and specificity of T-SPOT.TB were compared with those of ADA,TB-DNA and TB culture,the differences were all statistically significant(P<0.05),the area under ROC curve of T-SPOT.TB test was 0.893.Conclusions T-SPOT.TB may be more applicable for diagnosis of tuberculous serositis than ADA,TB-DNA and TB culture.

关 键 词：结核感染T细胞斑点试验 结核性浆膜炎 腺苷脱氨酶 结核分枝杆菌DNA 结核分枝杆菌培养 

分 类 号：R446.61[医药卫生—诊断学]