结核感染T细胞斑点试验对结核性胸膜炎的诊断价值

目的评价结核感染T细胞斑点试验(T-SPOT.TB)对诊断结核性胸膜炎的价值。方法前瞻性纳入疑诊结核性胸膜炎患者100例,进行外周血T-SPOT.TB、血清结核抗体、胸腔积液腺苷脱氨酶(ADA)检测,并比较外周血T-SPOT.TB、胸腔积液ADA、血清结核抗体检测诊断结核性胸膜炎的灵敏度。外周血T-SPOT.TB、胸腔积液ADA、血清结核抗体检测诊断结核性胸膜炎的灵敏度分别为92.6%、95.5%、36.4%;特异度分别为92.3%、75%、76.8%;阳性预测值分别为96.2%、91.7%、57.1%,阴性预测值分别为85.7%、85.7%、35.5%。T-SPOT.TB特异度与后两种方法比较,差异均有统计学意义(均P<0.05)。灵敏度及阳性预测值、阴性预测值与胸水ADA比较,差异均无统计学意义;与血清结核抗体比较,差异均有统计学意义(均P<0.05)。结论 T-SPOT.TB对诊断结核性胸膜炎有较高的灵敏度及特异度,对临床应用有重要的参考价值。

Objective To evaluate the value of T-SPOT. TB （tuberculous pleurisy） in the diagnosis of tuberculous pleurisy.Methods A total of 50 patients with clinically suspected TBP admitted were enrolled in this prospective cohort study. Peripheral blood T-SPOT.TB, ascetic adenosine deaminase （ADA） and serum tuberculosis antibody （TB-Ab） were measured in the 100 patients and we compared the diagnostic value of the 3 methods.Results According to the standard of diagnosis of TBP and grouping, 54 patients were diagnosed with tuberculous pleurisy. The sensitivity of T-SPOT.TB for the diagnosis of tuberculous pleurisy was 92.6% （50/54）, with statistical signiifcance when compared with serum TB-Ab 36.4% （16/44） （P〈0.05）, without statistical signiifcance when compared with ascitic ADA 95.5% （42/44）. The speciifcity of T-SPOT.TB for the identiifcation of non-tuberculous pleurisy was 92.3% （24/26）, with statistical significance when compared with serum TB-Ab 78.6% （22/28） and ascitic ADA 75% （12/16） （P〈0.05）. The positive prediction value of T-SPOT.TB for the diagnosis of tuberculous pleurisy was 96.2% （50/52）, with statistical signiifcance when compared with serum TB-Ab 57.1% （8/14） （P〈0.05）, and without statistical signiifcance when compared with ascitic ADA 91.7% （44/48）. The negative prediction value of T-SPOT.TB for the identiifcation of non-tuberculous pleurisy was 85.7% （24/28）, with statistical signiifcance when compared with serum TB-Ab 35.5% （22/62）, and ascetic ADA 85.7% （12/14） （P〈0.05）.Conclusion Peripheral blood T-SPOT. TB for the diagnosis of TBP is highly sensitive and speciifc, which is better than serum TB-Ab and ascitic ADA. T-SPOT.TB has an important reference for diagnosing suspected tuberculous pleurisy.