摘要
目的评价结核感染T细胞斑点试验(T-cell spot of tuberculosis test,T-SPOT.TB)在肺结核病中的诊断价值。方法通过对2015年10月~2016年10月在石河子大学第一附属医院疑诊为肺结核的1012例住院成年患者进行回顾性分析,依据最终诊断分为活动性结核组、陈旧性结核组、非结核患者组。所有患者均行T-SPOT.TB检测,诊断不明确且无卡介苗接种或陈旧性结核患者行结核菌素皮肤试验,根据T-SPOT.TB结果对T细胞斑点数进行比较分析。结果活动性结核组T细胞斑点数中位数67.0(32.8,133.5)显著高于陈旧性结核组的5.0(1.0,18.5)和非TB组的3.0(1.0,10.0)(P=0.000);肺结核组的T细胞斑点数中位数为85.0(37.0,140.0),高于肺外结核组40.4(8.0,106.0)(P=0.001)。T细胞斑点数分布范围在各组之间有重叠。T-SPOT.TB在肺结核中的灵敏度、特异度、阳性预测值、阴性预测值分别为91.00%、68.49%、61.34%、93.26%。受试者工作特性曲线(ROC曲线)分析显示,在活动性结核组中T-SPOT.TB的ROC曲线下面积(0.887)大于抗原A(0.874)和抗原B(0.868),以T细胞斑点数25.5作为区分活动性结核与潜伏性结核分枝杆菌感染(简称潜伏性结核感染)的最佳界值,其灵敏度和特异度分别是79.9%和79.4%。结论 (1)T细胞斑点数可反映体内的结核分枝杆菌负荷;(2)T-SPOT.TB在肺结核的诊断中具有较高的灵敏度和特异度;(3)以T细胞斑点数25.5作为区分动性结核与潜伏性结核感染的最佳界值,但需结合临床及其他检查结果。
Objective To evaluate the diagnostic value of T-cell spot of tuberculosis test（T-SPOT.TB） in pulmonary tuberculosis. Methods Retrospective analysis was conducted on 1012 hospitalized adults who were suspected of TB in the First Affiliated Hospital of Shihezi University from October 2015 to October 2016. Participants were divided into active tuberculosis group, old tuberculosis group and non-tuberculosis group according to the final diagnosis. All patients underwent T-SPOT.TB test. Tuberculin skin test were conducted to patients who had unclear diagnosis and no BCG vaccination or were old tuberculosis. T cell spots were compared according to the T-SPOT.TB results. Results The median number of T cell spots in active tuberculosis group was 67.0（32.8, 133.5） which was significantly higher than5.0（1.0, 18.5） in old tuberculosis group and 3.0（1.0, 10.0） in non-TB group, P=0.000. The median number of T-cell spots in the pulmonary tuberculosis group was 85.0（37.0, 140.0）, which was higher than that in the extrapulmonary tuberculosis group 40.4（8.0, 106.0）, P=0.001. The distribution of T cells was overlap between groups. The sensitivity, specificity,positive predictive value and negative predictive value of T-SPOT.TB in pulmonary tuberculosis were 91.00%, 68.49%,61.34% and 93.26%, respectively. The receiver operating characteristic curve（ROC curve） analysis showed that the area under the ROC curve of T-SPOT.TB in active tuberculosis group（0.887） was greater than that of antigen A（0.874） and antigen B（0.868）. The sensitivity and specificity were 79.9% and 79.4%, respectively, using 25.5 as the best cutoff value of T cell spot number for discriminating active tuberculosis from latent tuberculosis infection. Conclusion（1）T cell spots can reflect the number of mycobacterium tuberculosis load in vivo.（2）T-SPOT.TB in the diagnosis of tuberculosis has a high sensitivity and specificity.（3）25.5 can be used as the best cutoff value of T cell spot number between active tuberculosi
作者
骆瑞琦
季榕
LUO Ruiqi;JI Rong(Medical College of Shihezi University, Shihezi 832000,China;Department of Infectious Diseases, The First Affili- ated Hospital of the Medical College, Shihezi University, Shihezi 832000,China)
出处
《中国现代医生》
2018年第10期12-16,共5页
China Modern Doctor
