结核感染T细胞斑点试验检测对老年活动性肺结核的诊断价值

The diagnostic value of T-SPOT. TB in the elderly pulmonary tuberculosis

目的探讨结核感染T细胞斑点试验（T-SPOT．TB）检测在老年活动胜肺结核诊断中的价值。方法回顾性分析2012年1月至2014年12月我院住院老年患者444例，剔除不符合入选条件的患者86例，共纳入277例确诊老年活动性肺结核患者（其中菌阳组109例，菌阴组168例）和81例肺部其他疾病患者，应用卡方检验比较T-SPOT．TB检测在老年活动性肺结核和肺部其他疾病中的阳性率及其在菌阳组和菌阴组中的阳性率；计算T-SPOT．TB检测在老年活动性肺结核患者中的敏感度和特异度；比较T-SPOT．TB检测与抗结核抗体、痰及纤维支气管镜支气管肺泡灌洗液（bronchoalveolarlavagefluid，BALF）涂片（培养）和痰定量多聚酶链反应结核分枝杆菌核酸检测（TB-DNA-PCR）的敏感度和特异度。结果T-SPOT．TB检测在老年活动性肺结核中的敏感度为86．3％（239／277），特异度为63．0％（51／81），在菌阳组和菌阴组的阳性率分别为97．2％（106／109）和79．2％（133／168）（χ^2=18．259，P=0．000）；T-SPOT．TB检测与抗结核抗体，痰涂片（培养）、BALF涂片（培养）和痰TB-DNA-PCR相比，敏感度分别为86．3％（239／277）、44．3%（121／273）、39．4％（109／277）、21．1％（16／76）和36．7％（77／210），特异度分别为63．0％（51／81）、79．0％（64／81）、100．0%（81／81）、100．0%（47／47）和100．0％（70／70）。结论T-SPOT．TB检测在老年活动性肺结核中的敏感度较高，但特异度较低，其在老年肺结核鉴别诊断中的价值尚需进一步探讨。

Objective To evaluate the diagnostic value of T-SPOT. TB in the elderly pulmonary tuberculosis. Methods We retrospectively analyzed 444 elderly inpatients admitted in Beijing Chest Hospital Capital Medical University from Jan. 2012 to Dec. 2014. Eighty six cases were excluded due to not neet inclusion criteria. Two hun- dred and seventy seven cases （109 cases with smear positive and 168 cases with smear negative） with active pulmo- nary tuberculosis and 81 cases with other pulmonary diseases were enrolled. All cases received the T-SPOT. TB test. Statistics was used to analyze the data. Results The sensitivity and specificity of T-SPOT. TB in the elderly pul- monary tuberculosis were 86.3% and 63.0%, respectively. The sensitivity in patients with smear positive was 97.2%, higher than that 79.2% in patients with smear negative （X2 =18. 259 P= 0. 000）. Comparing with serum anti-mycobacterium tuberculosis antibody （TB-Ab） （44.3% in sensitivity and 79.0% in specificity）, acid-fast bacilli and/or mycobacterium tuberculosis culture from sputum （39.4% in sensitivity and 100.0% in specificity）, bronchoal- veolar lavage fluid （BALF）（21.1 % in sensitivity and 100.0 % in specificity） and sputum TB-DNA-PCR （36.7 % in sensitivity and 100.0% in specificity）, T-SPOT. TB has the highest sensitivity but the lowest specificity. Conclusion The performance of T-SPOT. TB in elderly pulmonary tuberculosis has a good sensitivity but poor spe- cificity. The differential diagnostic value need to be further evaluated.