结核感染T细胞斑点试验及A、B两种抗原检测在活动性结核病诊断中的意义

Significance of T-SPOT.TB test and two antigens A and B detection in diagnosis of active tuberculosis

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)及A、B两种抗原检测在活动性结核病诊断中的意义。方法将107例活动性结核病患者的T-SPOT.TB结果与最终临床诊断进行比较,评价其诊断灵敏度、特异度、阳性预测值和阴性预测值,并对T-SPOT.TB阳性斑点分布特点进行分析。结果 T-SPOT.TB诊断活动性结核病的灵敏度为86.0%(92/107),特异度为90.7%(88/97),阳性预测值91.1%(92/101),阴性预测值85.4%(88/103)。T-SPOT.TB两种抗原A和B的检测结果阳性率无统计学差异;阳性斑点分布特征分析显示,抗原A在低阳性斑点区呈现活动性结核病检出高峰,而抗原B则分别在高、低阳性斑点区呈现活动性结核病检出高峰,进一步分析抗原B在高阳性斑点区100～125的检出者均为肺外结核患者。结论 T-SPOT.TB对活动性结核病的诊断具有较好的临床应用价值,A、B两种抗原表现出不同的阳性检出规律和意义。

Objective To investigate the significance of tuberculous infection of T cells spot test (T-SPOT.TB test)and two antigens A and B detection in the diagnosis of active tuberculosis. Methods The sensitivity,specificity,positive predictive value and negative predictive value of T-SPOT.TB test from 107 patients with active tuberculosis were analyzed according to the final clinical diagnosis.The distribution characteristics of T-SPOT.TB test positive spots were analyzed.Results The sensitivity,specificity,positive predictive value,negative predictive value of T-SPOT.TB test were 86.0%(92/107),90.7%(88/97),91.1%(92/101) and 85.4%(88/103),respectively.There was no significant difference in the positive rate of tuberculosis diagnosis between two antigens of A and B.Positive spots distribution analysis showed that antigen A presented active tuberculosis peak detection in low positive spots range,while antigen B presented active tuberculosis peak detection both in low and high positive spots range,and the patients with high positive spots of antigen B range of 100-125 were all with extrapulmonary tuberculosis.Conclusion T-SPOT.TB test is favorable for the current diagnosis of tuberculosis as auxiliary diagnostic methods.The two antigens A and B show different patterns and significance of positive detection.