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四种方法联合检测对病原学阴性肺结核的诊断价值 被引量:5

Clinical diagnostic value of combining four methods in detecting etiologically negative pulmonary tuberculosis
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摘要 目的:分析结核感染T细胞斑点试验(T-SPOT.TB)、结核抗体(antibody,TB-Ab)、血红细胞沉降率(erythrocyte sedimentation rate,ESR)、超敏C-反应蛋白(high-sensitivity C-reaction protein,hs-CRP)联合检测在病原学阴性肺结核诊断中的价值。方法:收集2020年7月至2022年7月北京市疾病预防控制中心结核病门诊收治的初治且病原学检查阴性的肺结核患者216例(病原学阴性肺结核组),以及同期收治的病原学阳性的初治肺结核患者147例(病原学阳性肺结核组)和其他肺部疾病患者455例(其他肺部疾病组)。均行T-SPOT.TB、TB-Ab、ESR、CRP检测,以临床诊断为标准,分析四种方法单独及联合检测的诊断效能。结果:T-SPOT.TB在病原学阴性肺结核组中检测阳性率为82.4%(178/216),与病原学阳性肺结核组阳性率[87.8%(129/147)]相比较,差异无统计学意义(χ2=1.917,P=0.166),与其他肺部疾病组阳性率28.6%(130/455)相比较差异有统计学意义(χ2=160.746,P=0.000)。T-SPOT.TB对病原学阴性肺结核诊断的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为82.4%(178/216)、71.4%(325/455)、57.8%(178/308)、89.5%(325/363)、75.0%(503/671);四种方法联合诊断的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为91.7%(198/216)、53.4%(243/455)、48.3%(198/410)、93.1%(243/261)、65.7%(441/671)。T-SPOT.TB、TB-Ab、ESR、hs-CRP检测ROC曲线下面积(AUC)分别为0.764、0.600、0.529、0.515,联合检测的AUC为0.804。结论:T-SPOT.TB检测病原学阴性肺结核的敏感度、阴性预测值及准确度较好,四种方法联合检测的敏感度、阴性预测值和AUC较高,联合检测可提高病原学阴性肺结核的诊断效能。 Objective:To analyze the diagnostic value of combining T-cell spot test for tuberculosis infection(T-SPOT.TB),antibody(TB-Ab)test,erythrocyte sedimentation rate(ESR)test,and hypersensitive C-reactive protein(hs-CRP)test in detecting etiologically negative pulmonary tuberculosis(PTB).Methods:Data of 216 PTB patients who were initially treated and had negative etiological test results(etiologically negative PTB group)were collected from the Tuberculosis Clinic of the Beijing Center for Disease Prevention and Control from July 2020 to July 2022.Meanwhile 147 primary PTB patients with positive etiological test results and 455 patients with other pulmonary diseases who were admitted during the same period were classified as the etiologically positive PTB group and other lung disease group respectively.All of them were tested with T-SPOT.TB,TB-Ab,ESR,and hs-CRP to analyze the diagnostic performance of single test and combined tests with those four methods,based on clinical diagnosis.Results:The detection positive rate of T-SPOT.TB in etiologically negative PTB group was 82.4%(178/216),no statistically significant difference was observed comparing with the detection positive rate in etiologically positive PTB group(87.8%(129/147);χ2=1.917,P=0.166),but the difference was statistically significant(χ2=160.746,P=0.000),while comparing with the detection positive rate in other pulmonary disease group(28.6%,130/455).The sensitivity,specificity,positive and negative predictive value and accuracy of T-SPOT.TB were 82.9%(178/216),71.4%(325/455),57.8%(178/308),89.5%(325/363),75.0%(503/671),respectively.While for combination of all four methods,they were 91.7%(198/216),53.4%(243/455),48.3%(198/410),93.1%(243/261),65.7%(441/671),respectively.The area under ROC curve(AUC)of T-SPOT.TB,TB-Ab,ESR and hs-CRP test were 0.764,0.600,0.529 and 0.515,respectively,and the AUC of combining those four tests was 0.804.Conclusion:The sensitivity,negative predictive value and accuracy of the T-SPOT.TB test for detecting etiologically negative PT
作者 田丽丽 陈双双 樊瑞芳 张洁 王嫩寒 陈昊 代小伟 任怡宣 赵琰枫 李传友 丁北川 李波 于兰 易俊莉 王佩 杨新宇 宋卫萍 Tian Lili;Chen Shuangshuang;Fan Ruifang;Zhang Jie;Wang Nenhan;Chen Hao;Dai Xiaowei;Ren Yixuan;Zhao Yanfeng;Li Chuanyou;Ding Beichuan;Li Bo;Yu Lan;Yi Junli;Wang Pei;Yang Xinyu;Song Weiping(Tuberculosis Laboratory of Beijing Center for Disease Prevention and Control,Beijing 100035,China;Tuberculosis Outpatient Department of Beijing Center for Disease Prevention and Control,Beijing 100035,China;Office of Beijing Center for Disease Prevention and Control,Beijing 100013,China)
出处 《中国防痨杂志》 CAS CSCD 2023年第2期144-150,共7页 Chinese Journal of Antituberculosis
基金 首都卫生发展科研专项(首发2022-1G-3012)。
关键词 结核 临床实验室技术 酶联免疫吸附测定 C反应蛋白 对比研究 Tuberculosis,pulmonary Clinical laboratory techniques Enzyme-linked immunospot assay C-reaction protein Comparative study
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