结核感染T细胞斑点试验联合胸腔积液腺苷脱氨酶检测对胸腔积液患者中活动性肺结核病的早期诊断及疗效评估价值  

T-SPOT.TB combined with pleural effusion adenosine deaminase assay for early diagnosis and therapeutic evaluation of active pulmonary tuberculosis in patients with pleural effusion

作　　者：曹雯雯 刘欣 杨阳 CAO Wenwen;LIU Xin;YANG Yang(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Shandong First Medical University,Tai'an Shandong 271000,China)

机构地区：[1]山东第一医科大学第二附属医院呼吸与危重症医学科,山东泰安271000

出　　处：《中国感染与化疗杂志》2022年第3期282-288,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探究结核感染T细胞斑点试验(T-SPOT.TB)联合胸腔积液腺苷脱氨酶(ADA)检测对活动性肺结核患者的早期诊断及疗效评估价值。方法选取2016年1月—2018年6月在山东第一医科大学第二附属医院就诊的有肺部病灶伴胸腔积液患者201例,根据诊断标准分为活动性肺结核组和非结核组。对两组不同性别、年龄、体重指数(BMI)、吸烟史、糖尿病史等一般临床资料进行比较,同时对比两组患者的T-SPOT.TB和胸腔积液ADA相关生化指标。通过多因素logistic回归模型分析活动性肺结核发生的独立危险因素,在此基础上建立疗效评估模型,受试者工作特征(ROC)曲线对模型预测活动性肺结核患者疗效的准确性进行评估。结果两组患者的性别、年龄、BMI、球蛋白、吸烟史、糖尿病史、总胆红素、细菌感染、哮喘等差异无统计学意义,结核接触史、乙型肝炎、肝功能不全和结节性红斑差异有统计学意义。活动性肺结核组胸腔积液总蛋白、胸腔积液ADA和胸腔积液乳酸脱氧酶水平均高于非结核组,且TB-Ab检测阴性、胸腔积液T-SPOT.TB阳性、外周血T-SPOT.TB阳性、结核菌素(PPD)试验阴性患者比例均大于非结核组。胸腔积液总蛋白、胸腔积液ADA、PPD试验阴性、TB-Ab检测阴性、胸腔积液T-SPOT.TB阳性、外周血T-SPOT.TB阳性、肝功能不全、结核接触史为活动性肺结核发生的独立危险因素。PPD试验阴性、TB-Ab检测阴性、外周血T-SPOT.TB阳性分别与胸腔积液总蛋白、胸腔积液ADA、胸腔积液T-SPOT.TB呈正相关。ROC曲线显示胸腔积液T-SPOT.TB联合胸腔积液ADA、外周血T-SPOT.TB联合胸腔积液ADA更具有诊断价值。ROC曲线显示评分模型的曲线下面积为0.837,95%CI:0.751~0.897,提示模型预测准确性良好。结论T-SPOT.TB和胸腔积液ADA联合检测对于活动性肺结核具有较高的诊断价值,结合其他独立危险因素可能达到更好的疗效评估效�Objective To examine the value of T-SPOT.TB combined with pleural effusion adenosine deaminase assay in early diagnosis and efficacy evaluation of patients with active tuberculosis.Methods A total of 201 patients with pulmonary lesions and pleural effusion who were treated in the hospital from January 2016 to June 2018 were included and assigned to active tuberculosis or non-tuberculous group according to the diagnostic criteria.The two groups of patients were compared in terms of sex,age,body mass index(BMI),smoking history,diabetes history,T-SPOT.TB,pleural effusion adenosine deaminase(ADA),and other relevant markers.A multivariate logistic regression model was used to analyze the independent risk factors for active tuberculosis,which were used to construct a scoring model for efficacy evaluation.The model was evaluated by the receiver operating characteristic(ROC)curve for its performance in predicting the efficacy of patients with active tuberculosis.Results The patients with active tuberculosis were not significantly different from those without tuberculosis in terms of sex,age,BMI,globulin,smoking history,diabetes history,total bilirubin,bacterial infection,and asthma,but showed significant difference in history of tuberculosis exposure,hepatitis B,hepatic insufficiency,and erythema nodosum.The patients with active tuberculosis demonstrated higher total protein,ADA,and lactate dehydrogenase(LDH)levels in pleural effusion,higher proportion of negative tuberculosis antibody(TB-Ab)test,positive T-SPOT.TB test in pleural effusion and peripheral blood,and negative purified protein derivative(PPD)test than the tuberculosis-free patients.Total protein and ADA in pleural effusion,negative PPD test,negative TB-Ab test,positive T-SPOT.TB test in pleural effusion and peripheral blood,hepatic insufficiency,and exposure history were independent risk factors for recurrence in patients with active tuberculosis.Negative PPD test,negative TB-Ab test,and positive T-SPOT.TB test were positively correlated with the total prote

关 键 词：胸腔积液 活动性肺结核 结核感染T细胞斑点试验 疗效评估 腺苷脱氨酶 

分 类 号：R521[医药卫生—内科学]