外周血结核感染T细胞斑点试验在结核病中的应用价值研究

Clinical evaluation of peripheral blood T-SPOT.TB in diagnosis of tuberculosis

目的探讨外周血结核感染T细胞斑点试验(T-SPOT.TB)在结核病中的应用价值。方法回顾行T-SPOT.TB检查的住院疑似结核病患者536例;根据患者诊断分为结核病组和非结核病组;根据活动性、病变部位和化疗史将结核病患者分为活动性结核组和非活动性结核组,肺结核组、肺外结核病组和混合组,初治结核组和复治结核组。比较上述各组间T-SPOT.TB诊断价值以及分析肺外结核组各种结核病阳性率。结果 536例患者中有344例确诊为结核病,其中T-SPOT.TB试验阳性296例,阴性48例,灵敏度为86.0%(296/344);192例非结核病患者中,T-SPOT.TB阴性162例,特异度为84.4%(162/192)。非活动性结核组和活动性结核组阳性率分别为44.4%和88.4%(P<0.01)。肺结核组、肺外结核病组和混合组阳性率分别为87.3%、70.4%和94.3%(P<0.01);初治结核组和复治结核组阳性率分别为87.1%和100%(P<0.05)。肺外结核以结核性脑膜炎、胸膜炎和腹膜炎最常见,结核性脑膜炎阳性率最低为42.9%。结论外周血T-SPOT.TB试验在诊断住院患者结核病中具有很高的灵敏度和特异度;活动性结核和复治结核敏感度高于非活动性结核和初治结核;结核性脑膜炎敏感度不高,而在其它肺外结核具有较高临床应用价值。

Objective To evaluate the application of peripheral blood T-SPOT.TB assay for the diagnosis of tuberculosis. Methods Total 536 tuberculosis （TB） suspects were admitted in Wenzhou Central Hospital from April 2013 to August 2014, T-SPOT.TB assay was performed in all patients. The diagnostic value of T-SPOT.TB assay for tuberculosis was analyzed. Re- sults Among 536 TB suspects 344 patients were diagnosed as tuberculosis, in whom 296 cases were T-SPOT.TB positive with a diagnostic sensitivity of 86.0%. Among 192 non-tuberculosis patients 162 cases were T-SPOT.TB negative with a specificity of 84.4%. T-SPOT.TB positive rates in inactive TB and active TB group were 44.4% and 88.4%, respectively （Peripheral blood T-SPOT. TB assay is a promising test for diagnosis of TB in hospitalized patients with high sensitivity and specificity. χ2= 27.380, P〈0.05）. T-SPOT.TB positive rates in pulmonary TB, extrapulmonary TB and mixed groups were 87.3%, 70.4% and 94.3%, respectively. T-SPOT.TB positive rates in primary treatment and retreatment TB groups were 87.1% and 100.0%, respectively （P〈 0.05）. Tuberculous meningitis, pleurisy and peritonitist were the most common extrapulmonary tuberculosis, among which tuberculous meningitis had lowest T-SPOT.TB positive rate （42.9%）. test for diagnosis of TB in hospitalized patients with high sensitiv Conclusion Peripheral blood T-SPOT. TB assay is a promising ty and specificity.