联合检测结素试验和血清抗结核抗体对成人肺结核诊断预测价值:Bayesian分析

The predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection in diagnosis of adult pulmonary tuberculosis:a Bayesian analysis

目的 探讨结素试验及血清抗结核抗体对成人肺结核诊断的预测价值。方法 经细菌学、病理组织学或细胞学确诊的 1 34例肺结核病、1 0 9例胸部肿瘤及 5 1例肺部感染成人患者接受结素试验及血清抗结核抗体检查。比较结素试验不同硬结直径作阳性筛查标准及与血清抗结核抗体的不同组合对结核病诊断的价值。阳性预测价值和阴性预测价值的估计应用Bayes公式。结果 结素试验与血清抗结核抗体检测 ,两者结合可提高诊断价值 ,若以结素试验硬结直径≥ 1 5mm或血清抗结核抗体阳性作为阳性筛查标准 (标准 1 ) ,则阴性预测价值最大 ;若以结素试验硬结直径≥ 2 0mm及血清抗结核抗体阳性作为阳性筛查标准 (标准 2 ) ,则阳性预测价值最大。若就诊患者中肺结核患病率分别为 :0 .5 %,5 %,1 0 %,30 %,6 0 %时 ,标准 1的阴性预测价值分别为 :0 .999,0 .987,0 .972 ,0 .90 1 ,0 .72 3;标准 2的阳性预测价值均为 1 .0 0 0。结论 在结核高感染地区 ,联合检测结素试验及血清抗结核抗体对诊断成人结核病仍有辅助价值。结素试验硬结直径小于 1 5mm且血清抗结核抗体阴性对排除结核病有帮助 ;结素试验硬结直径≥ 2 0mm且血清抗结核抗体阳性 ,对确诊结核病有帮助。

Objective To evaluate the predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection for diagnosis of adult pulmonary tuberculosis.Methods Two hundred and ninety-four bacteriologically,patholgic histologically or cytologically proved adult patients received tuberculin skin test and detection of serum IgG antibody to a recombinant 38-kDa antigen from Mycobacterium tuberculosis,134 with TB,109 with chest tumors and 51 with pulmonary infections.The eligible non-TB patients were excluded those complicated with TB.The tuberculin test and the serum anti-Mycobacterium tuberculosis antibody detection were combined to form different positive results.To compare the diagnostic value of different combinations.The predictive value of a positive test and the predictive value of a negative test were estimated by Bayes's formula.Results The sensitivity of tuberculin test was higher than that of serum anti-Mycobacterium tuberculosis antibody detection.Whereas,the specificity of serum anti-Mycobacterium tuberculosis antibody detection was higher than that of tuberculin test.It can improve the diagnostic value while combined the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection.If a positive result was defined as the diameter of PPD skin test ≥15mm or a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria one),the predictive value of a negative test was the highest.If a positive result was defined as the diameter of PPD skin test ≥20mm and a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria two),the predictive value of a positive test was the highest.When the prevalence of tuberculosis was 0.5%,5%,10%,30%,60% respectively.The predictive value of a negative test for criteria one was 0.999,0.987,0.972,0.901,0.723 respectively.And the predictive value of a positive test for criteria two was 1.000.Conclusion In regions with a high prevalence of TB,combination the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection might still be useful for diagnosis of adult TB.It might exclude TB if one's diameter of PPD skin test <15mm and a negative of the serum anti-Mycobacterium tuberculosis antibody.It might be TB if one's diameter of PPD skin test ≥20 mm and a positive of the serum anti-Mycobacterium tuberculosis antibody.