超声引导下胸膜活检与外周血结核感染T细胞斑点试验对结核性胸膜炎的诊断价值

Diagnostic value of ultrasound-guided pleural biopsy and peripheral blood tuberculosis infection T cell spot test in tuberculous pleurisy

目的分析超声引导下胸膜活检联合外周血结核感染T细胞斑点试验（T-SPOT.TB）对结核性胸膜炎的诊断价值。方法采用随机数字表法随机抽取2012年1月至2016年12月解放军第三。九医院全军结核病研究所就诊的156例疑似结核性胸膜炎患者作为研究对象，其中确诊为结核性胸膜炎患者115例，非结核性胸膜炎患者41例。分别对两组患者先后进行超声引导下胸膜活检和外周血T-SPOT．TB检测，比较两种方法单独及联合诊断的效能。结果超声引导下胸膜活检、外周血T-SPOT．TB检测、联合诊断的敏感度分别为79．13％（91／115）、89．57％（103／115）、95．65％（110／115），联合诊断与各单项诊断比较差异均具有统计学意义（χ^2值分别是6．11、4．47，P值均〈0．05）。超声引导下胸膜活检、外周血T-SPOT．TB检测、联合诊断的特异度分别为100．00％（41／41）、85．37％（35／41）、100．00％（41／41），联合诊断与外周血T-SPOT．TB检测结果比较差异具有统计学意义（χ^2=4．82，P=0．028）。超声引导下胸膜活检、外周血T-SPOT．TB检测、联合诊断的阳性预测值分别为100．00％（91／91）、94．50％（103／109）、100．00％（110／110），联合诊断与外周血T-SPOT．TB检测结果比较差异具有统计学意义（χ^2=4．21，P=0．035）。超声引导下胸膜活检、外周血T-SPOT．TB检测、联合诊断的阴性预测值分别为63．08％（41／65）、74．47％（35／47）、89．13％（41／46），联合诊断与各单项诊断结果比较差异均具有统计学意义（y。值分别是9．42、4．87，P值均〈0．05）。超声引导下胸膜活检、外周血T-SPOT．TB检测、联合诊断的的诊断率分别为84．62％（132／156）、88．46％（138／156）、96．79％（151／156），联合诊断与各单项方法的诊断结果比较，差异均具有统计学意义（χ^2值分别是4．29、4．07，P值均〈0．05）。结论超声引导下胸膜活检联合外周血T-SPOT．TB检测对结核性胸膜炎有较高的诊断价值。

Objective To analyze the diagnostic value of ultrasound-guided pleural biopsy combined with pe- ripheral blood tuberculosis infection T cell spot test （T-SPOT. TB） in tuberculous pleurisy. Methods By using the random number table method, 156 suspected tuberculous pleurisy cases who visited the Tuberculosis Research Institute of Chinese PLA Hospital No. 309 between January 2012 and December 2016 were randomly selected as the subjects. Among them, 115 cases were diagnosed as tuberculous pleurisy and 41 cases with non-tuberculous pleuri- sy. All patients underwent ultrasound-guided pleural biopsy and peripheral hlood T-SPOT. TB, respectively. The diagnostic performance of each test alone and combined tests were compared. Results The sensitivity of ultra- sound-guided pleural biopsy, peripheral blood T-SPOT. TB, and combined tests was 79.13% （91/115）, 89.57%（103/115） and 95.65%（110/115）, respectively. The difference between combined diagnosis and each individual diagnosis was statistically significant （χ^2=6.11, 4.47; all P〈0. 05）. The specificity of ultrasound-guided pleural biopsy, peripheral blood T-SPOT. TB test, and combined diagnosis was 100.00% （41/41）, 85.37%（35/41）, and 100.00%（41/41）, respectively. There was statistical significance between the combined diagnosis and peripheral blood T-SPOT. TB test （χ^2=4.82, P=0.028）. The positive predictive value of ultrasound-guided pleural biopsy, peripheral blood T-SPOT. TB test, and combined diagnosis was 100.00% （91/91）, 94.50%（103/109）, and 100.00% （ 110/110）, respectively. There was statistical significance between the combined diagnosis and peripheral blood T-SPOT. TB test （χ^2=4.21, P=0. 035）. The negative predictive value of ultrasound-guided pleural biopsy, peripheral T-SPOT. TB test, and combined diagnosis was 63.08%（41/65）, 74. 470/oo （35/47）, and 89.13%（41/46）, respectively. The difference between combined diagnosis and each individual diagnosis was statistically significant （χ^2= 9.42, 4.87; all P〈0.05）. The diagnostic accuracy of ultrasound-guided pleura[ biopsy, peripheral blood T SPOT. TB test, and combined diagnosis was 84.62% （132/156）, 88. 460/00 （138/156）, and 96.79% （151/156）, respectively. The difference between combined diagnosis and each individual diagnosis was statistically significant （χ^2=4.29, 4.07; all P〈0.05）. Conclusion Ultrasound-guided pleural biopsy combined with peri- pheral blood T-SPOT. TB test is of high diagnostic value in detecting tuberculous pleurisy.