T-SPOT.TB在菌阳和菌阴结核病诊断中的应用价值

Evaluation of T-SPOT.TB assay in the diagnosis of bacteriological positive and negative tuberculosis

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)在菌阳和菌阴结核病诊断中的临床价值和意义。方法回顾性分析759例菌阳结核、468例菌阴结核和606例非结核患者的T-SPOT.TB检测结果,总结该方法对菌阳和菌阴结核的诊断性能,同时比较T-SPOT.TB中抗原A和抗原B在结核诊断中的效果及一致性。结果 T-SPOT.TB在结核诊断中的总体敏感度为91.9%,特异性为82.0%;在菌阳和菌阴结核中敏感度分别为95.5%和85.9%。抗原A和抗原B的阳性率在菌阳、菌阴和非结核患者三组内差异均无统计学意义(P>0.05),但抗原A和抗原B在菌阳结核诊断中一致性较差,表现为抗原A具有更好的敏感度,抗原B则特异性更高。结论 T-SPOT.TB试验对菌阳和菌阴结核均有较好的诊断价值,抗原A和抗原B在诊断中各具优势,两者联合使用有利于提高结核病诊断效果。

Objective To investigate the clinical significance of T-cell spot of tuberculosis（T-SPOT.TB） assay in the diagnosis of bacteriological positive and negative tuberculosis. Methods The T-SPOT.TB assay results were retrospectively analyzed in759 bacteriological positive tuberculosis, 468 bacteriological negative tuberculosis and 606 non-tuberculosis patients. The sensitivity and specificity of the assay were evaluated for tuberculosis diagnosis. Results The overall sensitivity and specificity of T-SPOT.TB assay were 91.9% and 82.0%, respectively. In bacteriological positive and negative tuberculosis patients, the sensitivities were 95.5% and 85.9%,respectively. Moreover, there was no statistical difference between antigens A and B in the positive ratio of tuberculosis diagnosis. However, in bacteriological positive tuberculosis antigen A exhibited a higher sensitivity, while antigen B showed a better specificity. Conclusion The T-SPOT.TB assay was a desirable method for the current diagnosis of bacteriological positive and negative tuberculosis. Antigens A and B showed different merits, and combination of them may be better for screening and clinical epidemiological investigation of tuberculosis.