结核感染T细胞斑点实验对结核性胸膜炎的诊断价值

Diagnostic value of T-SPOT.TB for tuberculous pleurisy

目的研究结核感染T细胞斑点实验（T—SPOT．TB）对结核性胸膜炎患者的诊断价值。方法比较T—SPOT．TB、ADA检测110例渗出性胸腔积液患者的阳性率、灵敏度、特异度、阳性预测值、阴性预测值等；比较治疗前后T—SPOT．TB斑点数的变化。结果T—SPOT．TB检测结核性胸膜炎患者的灵敏度、特异度、阳性预测值、阴性预测值、约登指数分别为89．66％、86．54％、88．14％、88．24％、0．76。ADA检测的灵敏度、特异度、阳性预测值、阴性预测值、约登指数分别为74．14％、75．00％、76．79％、72．22％、0．49。T—SPOT．TB的灵敏度、特异度明显高于ADA，差异有统计学意义（均P〈0．05）。抗结核治疗后的结核性胸膜炎患者经ESAT-6和CFP-10刺激产生的斑点数明显低于抗结核治疗前（均P〈0．05）。结论T—SPOT．TB对结核性胸膜炎有较好的辅助诊断价值，在抗结核治疗效果监测方面有一定的指导意义。

Objective To explore the value of T-SPOT.TB test in the diagnosis of tuberculous pleurisy. Methods The positive rate, sensitivity, specificity, positive predictive value, and negative predictive value of T-SPOT.TB and ADA were calculated and compared. Among these patients, 40 were retested by T-SPOT.TB after anti-tuberculosis treatment; and spot forming cells （SFCs） were compared before and after the treatment. Results The sensitivity, specificity, positive predictive value, and negative predictive value of T-SPOT.TB were 89.66%, 86.54%, 88.14%, 88.24%, and 0.76. And those of ADA were 74.14%, 75.00%, 76.79%, 72.22%, and 0.49. The sensitivity and specificity of T-SPOT.TB were significantly higher than those of ADA, with statistical differences （P〈0.05）. 40 patients were retested by the T-SPOT.TB after anti-TB treatment, and the results showed that ESAT- 6 and CFP-10 specific SFCs decreased significantly compared with those before anti-TB treatment （P〈0.05）. Conclusion T-SPOT.TB assay has an important clinical value in the diagnosis of tuberculous pleurisy and help us monitor treatment response.