胸水结核感染T细胞斑点试验联合腺苷脱氨酶在结核性胸膜炎诊断中的价值  

Diagnostic value of hydrothorax T-cell spot test combined with adenosine deaminase for tuberculous pleurisy

作　　者：金灵肖 金妙玲[2] 茅佳梁 张双丽[1] 赵旭宏[1] 黄海珍[1] 洪江浩 徐凯进[3] Jin Lingxiao;Jin Miaolin;Mao Jialiang;Zhang Xuangli;Zhao Xuhong;Huang Haizhen;Hong Jianghao;Xu Kaijin(Department of Infectious Diseases,Pujiang Hospital,Jinhua 322200,Zhejiang,China;Clinical Laboratory,Pujiang Hospital,Jinhua 322200,Zhejiang,China;State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,the First Affiliated Hospital,Zhejiang Universiity School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江省浦江县人民医院感染科,浙江金华322200 [2]浙江省浦江县人民医院检验科,浙江金华322200 [3]浙江大学医学院附属第一医院感染病中心传染病诊治国家重点实验室,杭州310003

出　　处：《国际流行病学传染病学杂志》2020年第6期497-500,共4页International Journal of Epidemiology and Infectious Disease

基　　金："十三五"国家科技重大专项 (2017ZX10105001);金华市科技局课题 (2018A453969)。

摘　　要：目的探讨胸水结核感染T细胞斑点试验(T-SPOT.TB)联合腺苷脱氨酶(ADA)在结核性胸膜炎中的诊断价值。方法收集2018年1月至2019年12月浦江县人民医院及浙江大学第一附属医院住院治疗的108例胸腔积液患者,其中结核性胸腔积液(结核组)72例,非结核性胸腔积液(非结核组)36例,所有患者行外周血T-SPOT.TB、胸水T-SPOT.TB、胸水ADA、胸水常规、生化指标检测,评估平行或联合诊断价值。结果结核组胸水ADA水平为(54.7±27.4)U/L,显著高于非结核组的(11.6±8.3)U/L,差异有统计学意义(t=9.21,P<0.05)。胸水T-SPOT.TB、外周血T-SPOT.TB、ADA单项检测对结核性胸膜炎诊断灵敏度分别是97.2%、93.0%、86.1%,特异性分别为91.7%、80.6%、63.9%;胸水T-SPOT.TB、血T-SPOT.TB、ADA平行联合诊断灵敏度更高,达98.6%;三种方法联合检测特异性高达94.0%,胸水T-SPOT.TB联合ADA检测诊断结核性胸特异性94.0%。结论胸水T-SPOT.TB试验对结核性胸膜炎诊断价值高,联合ADA检测可提高结核性胸膜炎的诊断率。Objective To explore the application value of T-cell spot test(T-SPOT.TB)combined with adenosine deaminase(ADA)in hydrothorax in the diagnosis of tuberculous pleurisy.Methods Totally 108 patients with pleural effusion in Pujiang Hospital and the First Affiliated Hospital,Zhejiang Universiity School of Medicine from January 2018 to December 2019 were recruited.In these patients,72 had tuberculous pleurisy(tuberculous group)and 36 had non-tuberculous pleurisy(non-tuberculous group).Peripheral blood T-SPOT.TB,T-SPOT.TB of hydrothorax,adenosine deaminase(ADA)of hydrothorax,routine test and biochemical indexes of hydrothorax were performed on all patients.The diagnostic values of parallel and serial combined tests were evaluated.Results The level of ADA in tuberculous group was(54.7±27.4)U/L,which was significantly higher than that of(11.6±8.3)U/L in non-tuberculous group(t=9.21,P<0.05).The sensitivities of T-SPOT.TB in hydrothorax,T-SPOT.TB in peripheral blood and ADA to the diagnosis of tuberculous pleurisy were 97.2%,93.0%and 86.1%,respectively,and the specificities were 91.7%,80.6%and 63.9%,respectively.In the three tests,the sensitivity of parallel combined testing was up to 98.6%,the specificity of serial combined examination was 94.0%.The specificity of hydrothorax T-SPOT.TB combined with ADA in diagnosis of tuberculous pleurisy was 94.0%.Conclusions The T-SPOT.TB of pleural effusion is of high value in the diagnosis of tuberculous pleurisy,and the combination with ADA test can improve the diagnostic accuracy of tuberculous pleurisy.

关 键 词：腺苷脱氨酶 结核感染T细胞斑点试验 结核性胸膜炎 联合诊断 

分 类 号：R521.7[医药卫生—内科学]