结核感染T细胞斑点试验在活动性结核诊断中的效果

Role of T-SPOT.TB test in diagnosis of active tuberculosis

目的:评价结核感染T细胞斑点(T-SPOT.TB)试验在活动性结核诊断中的价值。方法:收集行T-SPOT.TB试验的住院患者975例,对其临床资料与相关检验结果进行分析,并采用受试者工作曲线(ROC)确定该试验区分活动性结核的最佳阈值。结果:T-SPOT.TB试验结果显示,非活动性结核患者组(n=793)的阳性率为29.26%,活动性结核患者组(n=182)则为91.21%,表明该试验在活动性结核检测中有显著作用(P<0.001)。T-SPOT.TB试验的检测敏感度为0.912,特异度为0.707,综合而言优于传统的检测方法。对检测阈值进行优化发现当ESAT-6抗原刺激后斑点数阈值为11,CEP-10抗原刺激后斑点数阈值为9时,T-SPOT.TB试验对活动性结核的检测效能为最高。结论:T-SPOT.TB试验对活动性结核诊断效果较好,并可进一步对检测阈值进行优化,以更好地服务临床。

Objective To assess the value of T-SPOT.TB test in the diagnosis of active tuberculosis. Methods The clinical data of 975 hospitalized patients receiving T-SPOT.TB test were collected in our hospital. The clinical information and testing results were analyzed. The receiver operating curve （ROC） was used to determine the optimal threshold of T-SPOT.TB test for differentiating active tuberculosis. Results T-SPOT.TB test results showed that the positive rate was 29.26% for the non-active tuberculosis group （n = 793）, but was 91.21% for active tuberculosis patients group （n = 182） , which indicated that the test had a significant value in active tuberculosis detection （P 〈 0.001 ）. The sensitivity of T-SPOT.TB test was 0.912 and the specificity was 0.707. The detection threshold of T-SPOT.TB was optimized. As the spot-forming count （sfc） of ESAT-6 antigen threshold was 11.5 and that of the CEP- 10 threshold was 9.5, the efficiency of T-SPOT.TB test for detection of active pulmonary tuberculosis was the highest. Conclusions T-SPOT.TB test has a good diagnostic performance for active tuberculosis, and it can be further optimized to better serve the clinical practice.