结核感染T细胞斑点试验诊断结核性胸膜炎的应用价值

T-SPOT. TB clinical value in the diagnosis of tuberculous pleurisy

目的探讨结核感染T细胞斑点试验（T-SPOT.TB）在诊断结核性胸膜炎中的临床应用价值。方法选取2012年2月至2013年2月内蒙古医科大学附属医院呼吸科收治的胸腔积液住院患者60例,排除漏出液后均行血、胸水T-SPOT.TB检测,按最终临床诊断再分为结核性胸膜炎组和非结核性胸膜炎组。对结核性胸膜炎组患者规律抗结核3个月后随诊,再次行血T-SPOT.TB检测,以敏感性、特异性、阳性预测值、阴性预测值为评价目标,探讨T-SPOT.TB在结核性胸膜炎诊断中的应用价值。结果临床诊断为结核性胸腔积液患者36例,外周血T-SPOT.TB检测阳性32例,胸水T-SPOT.TB检测阳性36例,敏感性分别为88.9%、100.0%。24例非结核性胸腔积液患者中,外周血T-SPOT.TB检测阳性4例,胸水T-SPOT.TB检测阳性7例,特异性分别为88.9%、70.8%。外周血与胸水T-SPOT.TB检测的阳性预测值、阴性预测值分别是88.9%、83.3%、83.7%、100.0%。胸水T-SPOT.TB检测斑点形成细胞数平均是外周血的4~6倍,抗结核治疗后外周血斑点形成细胞数明显下降或缺失。结论外周血及胸水T-SPOT.TB检测对诊断结核性胸膜炎特异性及敏感性均较高,可以作为诊断结核性胸膜炎的一种快速、有效方法;胸水T-SPOT.TB检测对结核性胸膜炎的诊断价值优于外周血T-SPOT.TB检测;治疗前后血T-SPOT.TB检测可作为结核病情疗效评估。

Objective To research the tuberculous infection of Tcells spot test（ T-SPOT. TB） clinical value in the diagnosis of tuberculous pleurisy. Methods 60 cases of hospitalized patients with pleural effusion were enrolled between February 2012 to February 2013 in Inner Mongolia medical university affiliated hospital of respiratory medicine,eliminate leakage liquid are synchronous with blood and pleural effusion after T-SPOT.TB testing,according to the final clinical diagnosis group： tuberculous pleurisy group and non tuberculous pleurisy. Regular anti-tuberculosis treatment 3 months later,with the diagnosis of tuberculous pleurisy patients,again T-SPOT. TB test on peripheral blood,with sensitivity,specificity,positive predictive value,negative predictive value as evaluation target,discussed T-SPOT. TB applied value in the diagnosis of tuberculous pleurisy. Results Final diagnosis of 36 patients with tuberculous pleural effusion,peripheral blood T-SPOT.TB testing positive for 32 cases,pleurisy T-SPOT. TB testing positive for 36 cases,the sensitivity was 88. 9%,100%,respectively,non tuberculous pleural effusion patients,24 cases of peripheral blood T-SPOT. TB test positive for 4 cases,pleural effusion T-SPOT. TB test positive for 7 cases,specificity of 83. 3%,70. 8%. On peripheral blood and pleural effusion,the T-SPOT. TB test results positive predictive value,negative predictive value were 88. 9%,83. 3%,83. 7% and 100% respectively. Pleural effusion spots forming cell number average is plaque forming cell number 4-6 times,anti-tuberculosis peripheral blood spots forming cells was significantly decreased after treatment. Conclusions Peripheral blood and pleural effusion T-SPOT. TB test for the diagnosis of tuberculous pleurisy specificity and sensitivity is higher; can be diagnosed as tuberculous pleurisy a rapid and effective method. Pleural effusion T-SPOT. TB value to the diagnosis of tuberculous pleurisy is better than that of peripheral blood T-SPOT. TB testing. Before and after treatment the blood TSPOT. TB detection of tuberculous pleurisy curative effect evaluation can be performed.