摘要
目的通过检测胸腔积液患者外周血结核杆菌感染T细胞斑点试验(T.SPOT.TB),评价T.SPOT.TB对结核性胸膜炎的诊断价值及临床应用前景。方法收集2015年3月至2016年10月在宁夏医科大学总医院呼吸与危重症医学科住院部收治的结核性胸膜炎患者63例(TBP组),非结核性胸腔积液患者36例(NTBP组)。对入组患者进行常规胸水细胞学、生化以及腺苷脱氨酶(ADA)活性检测,并行外周血T.SPOT.TB检测,对比TBP组与NTBP组外周血T.SPOT.TB检测及胸水ADA活性检测对TBP的诊断效能。结果 TBP组EAST-6和CFP-10分泌IFN-γ的斑点形成细胞数分别为56/2.5×105个和38/2.5×105个,均高于NTBP组的0/2.5×105个和1/2.5×105个(Z=-6.92和-5.82,P均<0.01)。TBP组胸水ADA活性(39.60U·L-1)高于NTBP组(12.35U/L)(Z=-4.99,P<0.01)。T.SPOT.TB诊断TBP的敏感度(88.90%,56/63)高于ADA活性检测(46.00%,29/63)(χ~2=26.36,P<0.01);T.SPOT.TB诊断TBP的特异度(86.10%,31/36)与ADA活性检测(94.40%,34/36)的差异无统计学意义(χ~2=0.63,P>0.05);T.SPOT.TB诊断TBP的阴性预测值(81.60%,31/38)高于ADA的阴性预测值(50.00%,34/68)(χ~2=10.25,P<0.01);T.SPOT.TB检测的阳性似然比(6.40)与阴性似然比(0.13)均低于ADA活性检测(8.29,0.57)。两项检验方法联合时,诊断TBP的敏感度提高至92.10%(58/63)。结论外周血T.SPOT.TB检测对结核性胸腔积液具有很好的诊断价值,与ADA活性检测联合可提高TBP的诊断。
Objective To evaluate the effect of peripheral blood T-cell enzyme-linked immunosorbent spot assay（T.SPOT. TB）detection in patients with tuberculous pleurisy and its further clinical application.＆amp;nbsp;Methods63 patients with Tuberculous pleurisy（TBP group）and 36 patients with non-tuberculous pleural effusion（NTBP group）were enrolled in this study in department of respiratory and critical care medicine of general hospital of Ningxia Medical University from March 2015 to October 2016. All patients got conformed diagnosis by pathology or clinical manifestation. All enrolled patients got thoracentesis and saved pleural effusion for cytology,biochemistry,ADA activity detection and T.SPOT. TB assay. The results of the TBP and NTBP group T.S POT. TB assay and ADA activity detection were compared for the diagnosis of the TBP efficiency. ResultsThe result of CFP-10 and EAST-6 was 56/2.5×105 and 38/2.5＆215;105 in TBP group respectively and which were significantly higher than those in NTBP group（0/2.5＆215;105 and 1/2.5＆215;105,respectively）,EAST-6, Z=-6.92;CFP-10,Z=-5.82,P〈0.01）. The ADA activity（39.60U·L-1）was significantly higher in TBP group than that in NTBP group（12.35U·L-1）（Z=-4.99,P〈0.01）. The sensitivity of T.SPOT. TB assay（88.90%,56/63） was significantly higher than that of ADA activity（46.00%,29/63）in diagnosis of tuberculous pleurisy （χ2=26.36,P〈0.01）. There was no significant difference（χ2=0.63,P〉0.05）between the specificity of T.SPOT. TB assay（86.10%,31/36）and the ADA activity（94.40%,34/36）in diagnosis of tuberculous pleurisy. The negative predictive value of T.SPOT. TB assay（81.60%,31/38）was significantly higher than that of ADA （50.00%,34/68）（χ2=10.25,P〈0.01）. The positive likelihood ratio（6.40）and negative likelihood ratio（0.13） of T.SPOT.TB were significantly lower than that of ADA activity（8.29,0.57,respectively）. The combination of T.SPOT. TB assay and ADA activity,the diagnostic sensitivity increase
出处
《宁夏医科大学学报》
2017年第5期509-514,F0003,共7页
Journal of Ningxia Medical University
基金
国家自然科学基金(81360004)
宁夏回族自治区科技支撑计划项目(2015)
宁夏医科大学优势学科群建设科研项目(XY201615)
宁夏医科大学校级科研项目(2015)
关键词
结核性胸膜炎
T细胞斑点试验
腺苷脱氨酶
tuberculous pleurisy
T-cell enzyme-linked immunosorbent spot assay
adenosine deaminase
