结核感染T细胞斑点试验在临床诊断为肺外结核患者中的价值评价

Clinical evaluation of T-SPOT. TB test in patients clinical diagnosed extrapulmonary tuberculosis： a clinical review

目的探讨结核感染T细胞斑点试验（T-SPOT．TB）检测临床诊断为肺外结核患者中的价值，并且进行评价研究。方法采用回顾性分析方法分析上海市肺科医院2011年1月至2013年12月收治的临床诊断为肺外结核并行抗结核治疗或诊断性抗结核治疗的患者731例。收集所有患者的T-SPOT．TB检测结果，用SPSS16．0软件对结果进行统计学分析，观察组间样本率的比较采用y。检验，P〈0．05认为差异具有统计学意义。结果本研究中最终通过病理、细菌学及诊断性抗结核治疗共确诊肺外结核686例，其中T-SPOT．TB检测阳性者为656例，敏感度为95．63％（656／686）；本研究中最终排除肺外结核的患者共45例，其中T-SPOT．TB检测阴性者为37例，特异度为82．22％（37／45）；本研究中T-SPOT．TB检测阳性者共664例，阳性预测值为98．80％（656／664）；本研究中T-SPOT．TB检测阴性者共67例，故阴性预测值为55．22%（37／67）。对不同部位肺外结核TSPOT．TB分层分析，发现不同部位肺外结核的T-SPOT．TB检测阳性率具有一定差异，其中淋巴结结核T-SPOT．TB检测阳性率最高，达98．37％（181／184）。对于最终确诊肺外结核患者进行分组分析，初治组T-SPOT．TB检测阳性率为94．63％（476／503），复治组为98．36％（180／183），两者比较差异有统计学意义（χ^2=6．41，P〈0．05）；细菌学检查阳性组T-SPOT．TB检测阳性率为100．00％（32／32），而细菌学、病理学检查均阴性组TSPOT．TB检测阳性率为95．66％（551／576），两者比较差异有统计学意义（χ^2=4．14，P〈0．05）。合并活动性肺结核组T-SPOT．TB检测阳性率为95．45％（462／484），不合并活动性肺结核组T-SPOT．TB检测阳性率为96．04％（194／202），两者相比差异无统计学意义（χ^2=0．11，P=0．74）。结论T-SPOT．TB检测在临床诊断为肺外结核患者中具有较高的敏感度和特异度，阳性预测值也较高，但仍有一定的假阳性和假阴性；不同部位肺外结核T-SPOT．TB检测阳性率差异有统计学意义；细菌学阳性及复治肺外结核T-SPOT．TB检测阳性率可能更高。

Objective To study the clinical evaluation of T-SPOT. TB test in patients clinical diagnosed extrapulmonary tuberculosis. Methods We retrospectively analyzed the T-SPOT. TB results of 731 patients who were clinical diagnosed extrapulmonary tuberculosis from 2011.1-2013.12 in Shanghai pulmonary hospital. The results of T-SPOT. TB in all patients were collected and statistical analysis was done by SPSS 16.0. Comparison the difference between two groups using Chi-squared test. P〈0. 05 was considered statistically significant. Results We finally confirmed 686 cases of extrapulmonary tuberculosis through pathology, bacteriology and diagnostic treatment, 656 of them were T-SPOT. TB positive, the sensibility is 95.63% （656/686）;45 cases were finally excluded the diagnosis of extrapulmonary tuberculosis, 37 of them were T-SPOT. TB negative, the specificity is 82.22%（37/45） ; of all the 731cases,T-SP（YF. TB was positive in 664 cases,the positive predictive value is 98. 80% （656/664） ;T-SPOT.TB was negative in 67 cases, the negative predictive value is 55.22% （37/67）. Stratification analysis showed that the positive rate of T-SPOT. TB in different locations of extrapulmonary tuberculosis were different. Tuberculous lymphadenitis had the highest positive rate （98.37%, 181/184）. The positive rate of T-SPOT. TB in re-treatment patients （98.36%, 180/183） was significant higher than that in initial treatment patients （94.63 %,476/503）（x2 =6.41, P〈0.05）. The positive rate of T-SPOT. TB in patients who were bacteriogically positive （100%） was signifi- cant higher than those were negative both pathologically and bacteriologically （95.66%, 551/576）（χ^2= 4.14, P〈 0. 05）. The positive rate of T-SPOT. TB in patients wheher combined with active pulmonary （95.45% ,462/484） or not （96.04%,194/202） was no significant difference （χ^2 =0. ll,P=0.74）. Conclusion T-SPOT. TB has a high sensibility, specificity and positive predictive value in patients who were clinical diagnosed extrapulmonary tuberculo- sis, but there still could be false positive and false negative. The positive rate of T-SPOT. TB in different locations of extrapulmonary tuberculosis seemed to be different. Patients who were bacteriogically positive or re-treatment seemed to have higher positive rates of T-SPOT. TB.