T细胞斑点试验在儿童结核病诊断中的应用价值

Diagnostic value of T-SPOT for tuberculosis in children

目的:探讨外周血结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染T细胞斑点试验(TSPOT.TB)在儿童结核病诊断中的应用价值。方法:选取2015-08—2018-02在武汉市金银潭医院收治并确诊的70例结核病患儿为观察组,随机选取同期在儿童医院就诊的70例非结核病患儿为对照组。对入组患儿分别做T-SPOT.TB、结核分枝杆菌/利福平耐药基因检测(Xpert MTB/RIF)、MTB蛋白芯片、结核抗体(MTBAb)、荧光染色法和液体快速培养法检测,比较各项检测的应用价值。结果:观察组6种检测方法阳性率分别为58.57%、41.43%、30.00%、30.00%、12.86%、27.14%。T-SPOT.TB阳性率高于其他5种方法,差异有统计学意义(P<0.05)。T-SPOT.TB在肺内结核和肺外结核中检出的阳性率分别为63.41%和51.72%,差异无统计学意义(P>0.05),均高于其他方法。结论:T-SPOT.TB采用外周血标本容易留取,能显著提高灵敏度,有较高的特异度、阳性预测值、阴性预测值和诊断准确率,在肺内结核和肺外结核检测中均有较高的阳性率,有利于早期诊断和治疗并可防止漏诊,对儿童结核病的诊断具有重要的辅助诊断价值。

Objective:To invertigate the value of peripheral blood T-SPOT.TB in the diagnosis of tuberculosis in children.Method:A total of 70children who were admitted to our hospital and confirmed with TB between Au-gust 2015and February 2018were selected as observation group,70children who were excluded TB in a Children 's hospital during the same period were as control group.Peripheral blood T-SPOT.TB,Xpert MTB/RIF,protein-chip of Mycobacterium tuberculosis (MTB ), MTBAb,fluorescent staining and rapid liquid culture in the two groups were underwent detection to evaluate the clinical value.Result:Positive rates of six different methods in the obser-vation group were 58.57%,41.43%,30.00%,30.00%,12.86%and 27.14%.The sensitivity of T-SPOT.TB was significantly higher than that of the other five methods,and the differences were statistically significant (P <0.05). Posititive rates of T-SPOT.TB in pulmonary tuberculosis and ertrapulmonary tuberculosis were 63.41% and 51.72%respectively,which different was not statistically significant (P >0.05 ), and both were higher than that of other methods.Conclusion:T-SPOT.TB is easy to use peripheral blood specimens,which can improve the sensitivi-ty with a good specificity,positive predictive walue,negative predictive value and diagnostic accuracy,may help ear-ly diagnosis and treatment and prevent missed diagnosis,and have important auxiliary diagnostic value of TB a-mong children.