肺泡灌洗液与血液T细胞斑点试验对肺结核的诊断价值比较

Clinical Values of Pulmonary Alveolar Lavage Fluid vs. Blood T Cells Spot Test in the Diagnosis of Pulmonary Tuberculosis

目的对肺泡灌洗液、血液T细胞斑点试验诊断肺结核的临床价值进行对比研究。方法将2015年6月—2016年9月期间,我院接收的疑似肺结核病但还未接受相关药物治疗的92例患者纳入此次研究当中,全部给予肺泡灌洗液检查和血液T细胞斑点检查,对比两种检查方法的临床诊断价值。结果经临床确诊,疑似患者中有47例被确诊为肺结核患者。45例被确诊为非肺结核患者。肺泡灌洗液检查结果,肺结核诊断的敏感度为85.11%,非肺结核诊断的特异性为97.78%;血液T细胞斑点试验结果,肺结核诊断的敏感度为19.15%,非肺结核诊断的特异性为80.00%;肺泡灌洗液检查的敏感度和特异均显著高于血液T细胞斑点试验,差异有统计学意义(P<0.05)。肺泡灌洗液检查下的阳性预测值、阴性预测值和准确性分别为85.11%、86.27%和91.30%,均显著高于血液T细胞斑点试验检查的50.00%、48.65%、48.91%,差异有统计学意义(P<0.05)。结论与血液T细胞斑点试验相比,采用肺泡灌洗液检查进行肺结核的诊断,敏感度和特异性均更高;诊断的阳性预测值、阴性预测值以及准确性也更高,在结核病的诊断中的应用价值较高,能够作为临床诊断和治疗的有效参考。

Objective To compare of the clinical value of pulmonary alveolar lavage fluid examination vs. blood T cell spot test in the diagnosis of pulmonary tuberculosis. Methods 92 cases of suspected pulmonary tuberculosis in our hospital during the period from June 2015 to September 2016 were included in the study. All of them were given bronchoalveolar lavage fluid examination and blood T cell spot test. The clinical diagnostic value of the two methods was compared. Results After clinical diagnosis, 47 suspected cases were diagnosed as pulmonary tuberculosis and 45 as non - pulmonary tuberculo-sis. The sensitivity of pulmonary tuberculosis was 85. 11 % , the specificity of non - TB was 97. 78% . The sensitivity of diag-nosis was 19. 15 % and the specificity of non - tuberculosis diagnosis was 80. 00% . The sensitivity and specificity of the alveolar lavage fluid examination were significantly higher than those of the blood T cell spots （P 〈 0. 05 ） . The positive predictive value, negative predictive value and accuracy of the pulmonary alveolar lavage were significantly higher than that of the blood T cell spot test （85. 11% vs 50. 00 % , 86. 27% vs 48. 65% and 91. 30 % vs 48. 91% , respectively （ P 〈 0. 05 ） . Conclusion Compared with the blood T cell spot te s t , the alveolar lavage fluid examination has higher value for the diagnosis of pulmonary tuberculosis in view of sensitivity and specificity. The positive predictive value, negative predictive value and accuracy are also higher and it can be used as an effective reference for clinical diagnosis and treatment.