结核杆菌特异性细胞免疫与结核抗体辅助诊断男性生殖系统结核的价值  

Respective and joint values of mycobacterium tuberculosis-specific cellular immunity test and tuberculosis antibody test in diagnosis of male genital system tuberculosis

作　　者：张春雷 丁豪帅 康亚芬 孟冬冬 徐东波 杨琦 周逢海 常德辉 ZHANG Chunlei;DING Haoshuai;KANG Yafen;MENG Dongdong;XU Dongbo;YANG Qi;ZHOU Fenghai;CHANG Dehui(Department of Urology,No.940 Hospital of Joint Logistics Support Force of Chinese PLA,Lanzhou 730050,China;不详)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院泌尿外科,兰州730050 [2]甘肃省人民医院泌尿外科,兰州730050

出　　处：《实用医学杂志》2021年第20期2670-2674,共5页The Journal of Practical Medicine

基　　金：甘肃省自然科学基金(编号:18JR3RA406);兰州市科技发展重点支持项目(编号:2015-RC-16);中国人民解放军联勤保障部队第九四〇医院院内课题项目(编号:2021yxky057)。

摘　　要：目的评价结核杆菌特异性细胞免疫与结核抗体辅助诊断男性生殖系统结核的价值。方法回顾性分析2017年1月至2020年6月于我院就诊的174例男性生殖系统结核及炎症病例,通过比较各种检验方式(方法A:结核杆菌特异性细胞免疫检测;方法B:结核抗体检测;方法C:串联检测;方法D:并联检测)的诊断效能评估其辅助诊断男性生殖系统结核的价值。结果两种检测方法的一致性较差(kappa=0.022),诊断结果差异有统计学意义(χ^(2)=31.7,P<0.001)。方法A(81.6%)及方法D(84.2%)的敏感性高于方法B(21.1%,χ^(2)=19.4,P<0.01)及方法C(18.4%,χ^(2)=22.0,P<0.01),方法B(93.9%)及方法C(100.0%)的特异性高于方法A(59.2%,χ^(2)=11.1,P<0.01)及方法D(57.1%,χ^(2)=18.1,P<0.01);方法C具有最高的敏感度(Se)、阳性预测值(PPV)及阳性似然比(LR+),具有最低的误诊率(α),方法D具有最高的特异度(Sp)、阴性预测值(NPV)、约登指数,具有最低的漏诊率(β)及阴性似然比(LR-);方法A-D的AUC面积依次为0.704、0.575、0.592以及0.686。结论两种检验方法同时为阳性时患有生殖系统结核的可能性最大,此时误诊率最低;两种检验方法同时为阴性时患有生殖系统结核的可能性最小,此时漏诊率最低;单独检测时,结核杆菌特异性细胞免疫检测比结核抗体检测具有更高的诊断效能;联合检测时,并联诊断效能高于串联诊断效能。Objective To evaluate the repective and joint values of mycobacterium tuberculosis-specific cellular immunity test and tuberculosis antibody test in diagnosis of tuberculosis in male reproductive system.Methods A total of 174 cases of tuberculosis and inflammation in male reproductive system who were treated in our hospital from January 2017 to June 2020 were retrospectively analyzed to evaluate the diagnostic values of the two tests in assisting the diagnosis of tuberculosis in male reproductive system.The cases were divided into four groups with four test methods respectively(method A:mycobacterium tuberculosis-specific cellular immunity test,method B:tuberculosis antibody test,method C:serial test,method D:parallel test).Results The consistency of the two tests was poor(kappa=0.022),and the difference in diagnosis results was statistically significant(χ^(2)=31.7,P<0.001).The sensitivity of method A(81.6%)and method D(84.2%)was sigificanlty higher than that of method B(21.1%,χ^(2)=19.4,P<0.01)and method C(18.4%,χ^(2)=22.0,P<0.01).The specificity of method B(93.9%)and method C(100.0%)was higher than that of method A(59.2%,χ^(2)=11.1,P<0.01)and method D(57.1%,χ^(2)=18.1,P<0.01).Se,PPV,and LR+were at their highest level andαwas at the lowest in the method C group.Sp,NPV,Youden index were at their highest level,whileβand LR-were at their lowest in the method D group.The AUC areas of methods A to D were 0.704,0.575,0.592,and 0.686,respectively.Conclusion When the two test methods are positive at the same time,the possibility of reproductive system tuberculosis is the greatest,and the misdiagnosis rate is the lowest.When the two test methods are negative at the same time,the possibility of reproductive system tuberculosis is the least,and the missed diagnosis rate is the lowest.When tested alone,the tuberculosis specific cellular immune test has a higher diagnostic efficiency than the tuberculosis antibody test.When combined,the parallel diagnostic efficiency is higher than the serial diagnostic efficiency.

关 键 词：结核病 男性 生殖系统 结核杆菌特异性细胞免疫 结核抗体 诊断 

分 类 号：R446.11[医药卫生—诊断学]