多项指标联合检测对结核性胸膜炎的诊断价值研究  

Study on the diagnostic value of multiple indexes combined with detection of tuberculous pleurisy

作　　者：闫慧[1] 杜园园[1] 李鹏[1] 韩素丽[1] 苗泽丰 郭旭霞[1] YAN Hui;DU Yuan-yuan;LI Peng;HAN Su-li;MIAO Ze-feng;GUO Xu-xia(Clinical Laboratory,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046000,China)

机构地区：[1]长治医学院附属和平医院检验科,山西长治046000

出　　处：《中国卫生检验杂志》2021年第16期1935-1939,共5页Chinese Journal of Health Laboratory Technology

基　　金：山西省高等学校科技创新项目(2019L0707);长治医学院附属和平医院2019年度院级科研基金项目(HPYJ201920)。

摘　　要：目的探讨联合胸腔积液细胞形态学检查、腺苷脱氨酶检测(ADA)、结核感染T细胞检测(TB-IGRA)、结核基因检测(TB-DNA)和结核抗体检测(TB-Ab)对结核性胸膜炎的诊断价值评价。方法选取2019年月6月—2020年6月临床患者230例(包括结核组120例,非结核组110例),进行胸腔积液细胞形态学检查、腺苷脱氨酶检测(ADA)、结核感染T细胞检测(TB-IGRA)、结核基因检测(TB-DNA)和结核抗体检测(TB-Ab),分析其单项检测结果及联合应用诊断效能。结果细胞形态学检查、ADA、TB-IGRA、TB-DNA和TB-Ab 5项指标组成不同组合中,5项指标组合并联检测诊断结核性胸膜炎的敏感度最高(达97.50%);3项指标组合细胞形态学+TB-IGRA+ADA并联检测敏感度较高(94.17%);两项指标组合细胞形态学+TB-IGRA并联检测敏感度较高(91.67%),均高于单一指标检测敏感度,差异有统计学意义(χ^(2)=174.885,P <0.001);串联检测组合中,5项指标组合串联检测对诊断结核性胸膜炎的特异度最高(达99.09%);3项指标组合TB-IGRA+TB-DNA+TB-Ab串联检测特异度较高(92.73%);两项指标组合细胞形态学+TB-DNA检测特异度较高(90.00%),均较单一指标检测时特异度明显提高,差异有统计学意义(χ^(2)=35.242,P <0.001)。各组合之间比较差异均有统计学意义(χ^(2)值分别为36.073、107.085,P <0.001)。结论细胞形态学检查、ADA、TB-IGRA、TB-DNA和TB-Ab并联检测可提高对结核性胸膜炎诊断敏感性,串联检测可提高其特异度,并可根据实际情况合理选择多项指标的不同检测组合,具有很好的诊断效能及临床实用性。Objective To evaluate the diagnostic value of combined pleural effusion cell morphological examination,adenosine deaminase test( ADA),tuberculosis infected T cell test( TB-IGRA),tuberculosis gene test( TB-DNA) and tuberculosis antibody test( TB-Ab) in tuberculous pleurisy. Methods From June 2019 to June 2020,230 clinical cases( 120 cases in tuberculosis group,110 cases in non-tuberculosis group) were collected for pleural effusion cells morphological examination,adenosine deaminase( ADA),tuberculosis infected T cells detection( TB-IGRA),tuberculosis( TB-DNA) genetic testing and tuberculosis antibody detection( TB-Ab),and the results of single detection and the diagnostic efficiency of combined application were analyzed. Results Among the different combinations of the five indexes( morphological examination of cells,ADA,TB-IGRA,TB-DNA and TB-Ab),the sensitivity of the five indexes in parallel detection was the highest( up to97. 50%). The sensitivity of cell morphology + TB-IGRA + ADA in parallel was higher( 94. 17%). The sensitivity of the combined cell morphology + TB-IGRA was higher( 91. 67%) than that of the single indicator,and the difference was statistically significant( χ^(2)= 174. 885,P < 0. 001). Among the tandem test combinations,the specificity of the five-index tandem test for the diagnosis of tuberculous pleurisy was the highest( 99. 09%). The combination of TB-IGRA + TB-DNA + TB-Ab was highly specific( 92. 73%). The specificity of the combined cell morphology + TB-DNA detection was higher( 90. 00%),which was significantly higher than that of the single indicator detection,and the difference was statistically significant( χ^(2)=35. 242,P < 0. 001). There were statistically significant differences in sensitivity and specificity among the combinations( χ^(2)=36. 073,107. 085,P < 0. 001). Conclusion For tubercular pleurisy,the parallel detection of cell morphological examination,ADA,TB-IGRA,TB-DNA and TB-Ab can improve the diagnostic sensitivity,while serial detection can improve the specificity,and d

关 键 词：结核性胸膜炎 联合检测 细胞形态学 腺苷脱氨酶检测 结核感染T细胞检测 结核基因检测 结核抗体检测 

分 类 号：R446[医药卫生—诊断学]