结核感染T细胞斑点试验对结核性腹膜炎的诊断价值

t-SPOt.tB in the diagnosis of tuberculous peritonitis

目的:评价结核感染T细胞斑点试验(T-SPOT.TB)对诊断结核性腹膜炎(tuberculous peritonitis,TBP)的价值。方法:前瞻性纳入疑诊结核性腹膜炎患者50例,进行外周血T-SPOT.TB、结核菌素纯蛋白衍生物(purifiedprotein derivatives of tuberculin,PPD)皮试、血清结核抗体、腹水腺苷脱氨酶(adenosine deaminase,ADA)检测,并比较4种方法的诊断价值。结果:根据诊断及分组标准,最终诊断TBP 24例,非结核性腹膜炎17例,无法确定者9例,外周血T-SPOT.TB、PPD皮试、血清结核抗体、腹水ADA诊断TBP的灵敏度分别是91.7%(22/24),37.5%(9/24),16.7%(4/24),36.4%(8/22);特异度分别是76.5%(13/17),70.0%(7/10),78.6%(11/14),100%(14/14);阳性预测值分别是84.6%(22/26),75.0%(9/12),57.1%(4/7),100.0%(8/8);阴性预测值分别是86.7%(13/15),31.8%(7/22),35.5%(11/31),50.0%(14/28)。T-SPOT.TB灵敏度及阴性预测值与后3种方法比较,差异均有统计学意义(均P<0.05)特异度及阳性预测值与后3种方法比较,差异均无统计学意义(均P>0.05)。结论:外周血T-SPOT.TB对诊断TBP具有较高的灵敏度及阴性预测值,对疑诊结核性腹膜炎的患者进行快速而准确的诊断具有重要的参考价值。

Objective： To evaluate the value of T-SPOT.TB in the diagnosis of tuberculous peritonitis （TBP）. Methods： A total of 50 patients with clinically suspected TBP admitted from August 2011 to July 2012 from the Third Xiangya Hospital were enrolled in this prospective cohort study. Peripheral blood T-SPOT.TB, purified protein derivatives of tuberculin （PPD） skin test, serum tuberculosis antibody （TB-Ab） and ascitic adenosine deaminase （ADA） were measured in the 50 patients and we compared the diagnostic value of the 4 methods.