结核感染T细胞斑点试验联合胸腔积液腺苷脱氢酶检测对结核性胸腔积液的诊断价值研究  

Diagnostic value of the tuberculosis infection T cell spot test combined with pleural effusion gland adenosine deaminase in tuberculous pleural effusion

作　　者：李曼[1] 李倩[1] 徐美丽[1] 程欢欢 杨娜 杜月菊[1] LI Man;LI Qian;XU Meili;Cheng Huanhuan;Yang Na;Du Yueju(Clinical Lab,Hebei Chest Hospital,Hebei Provincial Key Laboratory of Lung Disease,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院检验科河北省肺病重点实验室,石家庄050041

出　　处：《传染病信息》2023年第2期142-146,共5页Infectious Disease Information

摘　　要：目的分析结核感染T细胞斑点试验(tuberculosis infection T cell spot test,T-SPOT.TB)结合胸腔积液生化检测对结核性胸腔积液的诊断价值。方法对2019年2月—2022年2月期间就诊于河北省胸科医院的126例有肺部病灶伴胸腔积液患者展开研究,所有患者均完成T-SPOT.TB试验和入院当天的胸腔积液生化检测,依据是否存在结核杆菌感染将其分为结核组(n=48,确诊为结核性胸腔积液)和对照组(n=78,确诊为非结核性肺部病灶伴胸腔积液)。统计并比较2组患者的各项一般资料和临床资料,Logistic多因素分析结核性胸腔积液的危险因素,并应用ROC曲线分析胸腔积液T-SPOT.TB和胸腔积液腺苷脱氨酶(adenosine deaminase,ADA)及2者联合对结核性胸腔积液的诊断价值。结果Logistic多因素分析结果显示,结核病接触史、结核性胸腔积液结核菌素试验阴性率较高、胸腔积液T-SPOT.TB阳性、胸腔积液ADA≥45U/L为发生结核性胸腔积液的危险因素(P均<0.05)。ROC曲线分析显示胸腔积液T-SPOT.TB和胸腔积液ADA诊断结核性胸腔积液的最佳临界值分别为276.43×10^(6)/ml和45.36 U/L,AUC分别为0.67和0.63,灵敏度分别为74.26%和69.26%,特异度分别为72.17%和68.84%,2者联合诊断的AUC为0.86,灵敏度为81.65%,特异度为79.43%。结论T-SPOT.TB结合胸腔积液检测对诊断结核性胸腔积液患者有较佳价值。Objective To investigate the diagnostic value of tuberculosis infection T cell spot(T-SPOT.TB)combined with pleural effusion adenosine deaminase(ADA)in tuberculous pleural effusion.Methods The study was conducted on 126 patients with lung lesions and pleural effusion who admitted to Hebei Chest Hospital from February 2019 to February 2022.All patients completed both T-SPOT.TB test and ADA detection were divided into tuberculosis group(n=48,diagnosed as tuberculous pleural effusion)and control group(n=78,diagnosed as non-tuberculous pulmonary lesions with pleural effusion)according to the presence or absence of tuberculosis bacilli infection.The demographic,history of diseases,and clinical information of the 2 groups were compared.Logistic multivariate analysis was used to analyze the risk factors of tuberculous pleural effusion,and receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of T-SPOT.TB,ADA of pleural effusion,and combined methods for tuberculous pleural effusion.Results Logistic multivariate analysis showed that the tuberculosis contact history,the high negative rate of tuberculous pleural effusion tuberculin test,positive T-SPOT.TB,and ADA≥45 U/L in pleural effusion were risk factors of tuberculous pleural effusion(P<0.05).The ROC curve analysis shows that the optimal critical values for diagnosing tuberculous pleural effusion with T-SPOT.TB and ADA in pleural effusion are 276.43×10^(6)/ml and 45.36 U/L,AUC was 0.67 and 0.63,sensitivity was 74.26%and 69.26%,specificity was 72.17%and 68.84%,respectively.Further analysis revealed that the AUC of T-SPOT.TB combined with ADA was 0.86,with a sensitivity of 81.65%and specificity of 79.43%.Conclusion T-SPOT.TB combined with pleural effusion detection has a better diagnosis value of pleural effusion tuberculosis.

关 键 词：结核性胸腔积液 结核感染T细胞斑点试验 胸腔积液检测 危险因素 

分 类 号：R521[医药卫生—内科学]