结核特异性抗原/植物血凝素比值在骨结核诊断中的价值  

Value of TBAg/PHA in the diagnosis of bone tuberculosis

作　　者：张妮[1] 赵越 周静芳 陈晓丽 刘素玲 ZHANG Ni;ZHAO Yue;ZHOU Jingfang;CHEN Xiaoli;LIU Suling(Department of Clinical Laboratory,Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院/广东省医学科学院检验科,广州510080

出　　处：《临床与病理杂志》2024年第9期1234-1241,共8页Journal of Clinical and Pathological Research

基　　金：广东省人民医院国家自然科学基金启动项目(8220080570);广东省基础与应用基础研究基金(2021A1515220022)。

摘　　要：目的:中国结核病的预估发病率位列全球第三,肺外结核中最常见的是骨结核,准确及快速诊断骨结核对疾病的治疗与预防至关重要。本研究拟评价结核感染T细胞斑点试验(T cell spot assay of tuberculosis infection,TSPOT.TB)中结核特异性抗原(tuberculosis-specific antigen,TBAg)/植物血凝素(phytohemagglutinin,PHA)比值在骨结核辅助诊断中的临床应用价值。方法:收集广东省人民医院2019年12月至2024年5月收治的88例疑似骨结核患者标本,其中男56例,女32例;年龄为7~91(55.46±17.04)岁。采集患者外周血进行T-SPOT.TB,计算TBAg/PHA比值,评价其辅助诊断骨结核的阳性预测值、阴性预测值、敏感度和特异度,并采用受试者操作特征曲线下面积(area under the curve,AUC)评估TBAg/PHA比值的诊断效能。结果:TBAg/PHA比值辅助诊断骨结核的阳性预测值为58.62%,阴性预测值为86.67%,敏感度为89.47%,特异度为52.00%,AUC为0.858,最佳临界值为0.023。结论:TBAg/PHA比值能显著提高T-SPOT.TB对骨结核诊断的特异度,在骨结核诊断中有良好的应用潜力。Objective:China ranks third globally in estimated tuberculosis incidence,with bone tuberculosis being the most common form of extrapulmonary tuberculosis.Accurate and rapid diagnosis of bone tuberculosis is crucial for effective treatment and prevention.This study aims to evaluate the clinical utility of the tuberculosis-specific antigen(TBAg)/phyto-hemagglutinin(PHA)ratio from the T cell spot assay of tuberculosis infection(T-SPOT.TB)test in assisting the diagnosis of bone tuberculosis.Methods:Samples from 88 suspected bone tuberculosis patients admitted to Guangdong Provincial People’s Hospital between December 2019 and May 2024 were collected.Among the patients,56 were male and 32 were female,with ages ranging from 7 to 91(55.46±17.04)years.Peripheral blood was analyzed using the T-SPOT.TB test,and the TBAg/PHA ratio was calculated.The positive predictive value,negative predictive value,sensitivity,and specificity of the TBAg/PHA ratio in diagnosing bone tuberculosis were assessed.The diagnostic performance was evaluated using the area under the curve(AUC)of receiver operating characteristic.Results:The TBAg/PHA ratio demonstrated a positive predictive value of 58.62%,a negative predictive value of 86.67%,a sensitivity of 89.47%,and a specificity of 52.00%.The AUC was 0.858,with an optimal cutoff value of 0.023.Conclusion:The TBAg/PHA ratio significantly enhances the specificity of the T-SPOT.TB test in diagnosing bone tuberculosis and shows good potential for clinical application in bone tuberculosis diagnosis.

关 键 词：骨结核 结核感染T细胞斑点试验 结核特异性抗原/植物血凝素比值 特异度 

分 类 号：R52[医药卫生—内科学]