脑脊液与外周血T-SPOT.TB检测在结核性脑膜炎诊断中的临床应用价值

Clinical application value of CSF and peripheral blood T-SPOT.TB detection in diagnosis of tuberculous meningitis

目的探讨脑脊液与外周血结核感染T细胞斑点试验(T-SPOT.TB)在结核性脑膜炎(TBM)诊断中的临床价值。方法选取2015年9月至2016年9月该院收治的35例TBM患者和40例非TBM患者分别作为观察组和对照组,采用TSPOT.TB检测脑脊液和外周血单个核细胞中结核分枝杆菌效应T细胞。结果观察组脑脊液、外周血T-SPOT.TB检测的阳性率(97.14%、80.00%)明显高于对照组(2.50%、0.00%),差异有统计学意义(P<0.05);脑脊液T-SPOT.TB检测的灵敏度、阴性预测值(97.14%、97.50%)明显高于外周血(80.00%、85.11%),差异有统计学意义(P<0.05);脑脊液T-SPOT.TB检测的特异度、阳性预测值(97.50%、97.14%)和外周血(100.00%、100.00%)比较,差异无统计学意义(P>0.05)。结论脑脊液和外周血T-SPOT.TB检测可对TBM提供早期诊断依据,且脑脊液T-SPOT.TB检测灵敏性较高,具有重要的临床应用价值。

Objective To research the clinical value of cerebrospinal fluid and peripheral blood tuberculosis infection T cell spot test（T-SPOT.TB）in the diagnosis of tuberculous meningitis（TBM）.Methods 35 cases of TBM and 40 cases of non-TB intracranial infection in this hospital from September 2015 to September 2016 were selected as the observation group and control group respectively.T-SPOT.TB was adopted to detect mycobacterium tuberculosis effector T cells in cerebrospinal fluid and detect peripheral blood mononuclear cells.Results The T-SPOT.TB detection positive rates of cerebrospinal fluid and peripheral blood in the observation group were 97.14% and 80.00% respectively,which were significantly higher than 2.50% and 0.00%in the control group,the difference was statistically significant（P0.05）;the sensitivity and negative predictive value in cerebrospinal fluid TSPOT.TB detection were 97.14% and 97.50%,which were significantly higher than 80.00% and 85.11%in peripheral blood TSPOT.TB detection,the difference was statistically significant（P0.05）;the specificity and positive predictive value in the cerebrospinal fluid T-SPOT.TB detection was 97.50% and 97.14% respectively,while which in peripheral blood T-SPOT.TB detection were 100.00% and 100.00% respectively,but the difference between the two groups was not statistically significant（P0.05）.Conclusion The detection of cerebrospinal fluid and peripheral blood T-SPOT.TB detection can provide early diagnostic basis for TBM,moreover cerebrospinal fluid T-SPOT.TB detection has higher sensitivity and possesses an important clinical application value.