T-SPOT.TB对风湿免疫病患者活动性肺结核诊断准确性的影响因素分析

A analysis of risk factors of T-SPOT.TB′s diagnostic accuracy in rheumatic immunologic diseases patients with active tuberculosis

目的探讨结核杆菌T细胞斑点实验(T-SPOT.TB)对风湿免疫病疑似伴发活动性肺结核患者诊断准确性的影响因素。方法回顾性分析2017年5月至2019年5月该院就诊的100例疑似伴发活动性肺结核的风湿免疫病患者的临床资料、临床诊断结果、T-SPOT.TB检查结果。分析T-SPOT.TB对风湿免疫病患者伴发活动性肺结核的诊断效能,并应用Logistic回归方法分析T-SPOT.TB检查假阳、假阴结果产生的相关因素。结果T-SPOT.TB诊断风湿免疫病患者伴发活动性肺结核的灵敏度、特异度、阳性预测值、阴性预测值分别为81.08%、42.31%、80.00%、44.00%;T-SPOT.TB假阳性患者存在结核既往史、吸烟史的例数大于真阳性+真阴性患者(P<0.05);T-SPOT.TB假阴性患者结核性胸膜炎、结核性脑膜炎例数与真阳性+真阴性患者比较,差异有统计学意义(P<0.05);Logistic回归分析显示,结核既往史(OR=6.185,P=0.011)、吸烟史(OR=22.322,P=0.005)为T-SPOT.TB产生假阳性结果的危险因素,结核性胸膜炎(OR=13.827,P=0.003)、结核性脑膜炎(OR=20.303,P=0.001)为T-SPOT.TB产生假阴性结果的危险因素。结论结核既往史、吸烟史是疑似伴发活动性肺结核的风湿免疫病患者T-SPOT.TB诊断假阳性的危险因素,伴发结核性胸膜炎或结核性脑膜炎是T-SPOT.TB假阴性的危险因素。

Objective To explore interfering factors of diagnostic accuracy of T-cell spot of tuberculosis test(T-SPOT.TB)in rheumatic immunologic diseases patients with suspected active tuberculosis.Methods Retrospective analysing clinical data,clinical diagnostic results,T-SPOT.TB result of 100 rheumatic immunologic diseases patients with suspected active tuberculosis treated in a hospital from May 2017 to May 2019.Analysing diagnostic accuracy of T-SPOT.TB in rheumatic immunologic diseases patients with tuberculosis,and analysing risk factors of T-SPOT.TB′s false positive and false negative results.Results The sensitivity,specificity,positive predictive value,negative predictive value of T-SPOT.TB diagnosis tuberculosis in rheumatic immunologic diseases patients were 81.08%,42.31%,80.00%,44.00%;Patients with past history of tuberculosis and smoking history in false-positive patients were higher than those in the true-positive+true-negative patients(P<0.05);There were significant different between false-negative patients and true-positive+true-negative patients in the number of patients with tuberculous pleurisy and tuberculous meningitis(P<0.05);Logistic regression analysis showed that a past history of tuberculosis(OR=6.185,P=0.011),smoking history(OR=22.322,P=0.005)were risk factors of T-SPOT.TB′s false-positive result,tuberculous pleurisy(OR=13.827,P=0.003)and tuberculous meningitis(OR=20.303,P=0.001)were risk factors of T-SPOT.TB′s false-negative result.Conclusion The history of tuberculosis and smoking are risk factors of T-SPOT.TB′s false positive result in rheumatoid immune disease patients with suspected active tuberculosis,tuberculous pleurisy or tuberculous meningitis are risk factors for T-SPOT.TB′s false negative result.