结核感染T细胞斑点试验在结核性浆膜炎中的诊断价值

The diagnostic value of T-SPOT. TB in tuberculous serositis

目的评价浆膜腔积液和外周血结核感染T细胞斑点试验(T-SPOT.TB)在结核性浆膜炎诊断中的临床应用价值。方法检测浆膜腔积液T-SPOT.TB、腺苷酸脱氨酶(ADA)和外周血T-SPOT.TB,评价其在结核性浆膜炎诊断中的敏感度、特异度、阴性预测值和阳性预测值。结果浆膜腔积液T-SPOT.TB诊断结核性浆膜炎的敏感度为95.83%,显著高于外周血T-SPOT.TB(75.00%)和浆膜腔积液ADA(70.83%),差异有统计学意义(P<0.01)。浆膜腔积液T-SPOT.TB的阴性预测值为90.48%,显著高于外周血T-SPOT.TB和浆膜腔积液ADA(60%、51.72%),差异有统计学意义(P<0.01)。浆膜腔积液T-SPOT.TB诊断临界值为86 SFCs/106,特异度为83.3%。浆膜腔积液T-SPOT.TB曲线下面积是0.928,显著高于外周血T-SPOT.TB和胸腔积液ADA曲线下面积(0.790、0.804)。结论浆膜腔积液T-SPOT.TB诊断效能明显高于外周血T-SPOT.TB和浆膜腔积液ADA,可作为诊断结核性浆膜炎有效的辅助手段。

Objective To evaluate the clinical value of the detection of serous cavity effusion and T - SPOT. TB in peripheral blood in the diagnosis of tuberculous serositis. Methods To evaluate the sensitivity, specificity, negative predictive value and positive pre- dictive value in the diagnosis of tuberculous serositis by the detection of T- SPOT. TB, adenosine deaminase （ADA） and T- SPOT. TB in peripheral blood in serous cavity effusion. Results The sensitivity of T - SPOT. TB was significantly higher in serous cavity ef- fusion（95.83% ） than that in peripheral blood（75.00% ） and serous effusion ADA（70.83% ）, and the differences were statistical- ly significant（P 〈0.01 ）. The negative predictive value of T - SPOT. TB in serous cavity effusion was 90.48%, which was signifi- cantly higher than that of T - SPOT. TB in peripheral blood（60.00% ） and serous effusion ADA（72% ）, with the differences sta- tistically significant （P 〈0.01 ）. The diagnosis value of T - SPOT. TB in serous cavity effusion was 86 SFCs/106, and the specific- ity was 83.3%, the area under the T - SPOT. TB curve of serous cavity effusion was 0. 928, which was significantly higher than that of area under the T - SPOT. TB curve of peripheral blood （0. 790 ） and pleural effusion ADA （ 0. 804 ）. Conclusion The diagnosis efficacy of T - SPOT. TB in serous cavity effusion was significantly higher than that of T - SPOT. TB in peripheral blood and serous effusion ADA. It can be used as an effective supplementary method for the diagnosis of tuberculous serositis.