外周血结核感染T细胞斑点试验在妊娠期结核病诊断中的价值

Clinical value of T-SPOT.TB in diagnosis of tuberculosis in pregnancy

目的评价外周血结核感染T细胞斑点试验(T-SPOT.TB)在妊娠期结核病诊断中的应用价值。方法回顾性分析2012年5月—2017年12月在北京胸科医院住院的25例根据细菌学或临床诊断的妊娠期结核病患者,及32例妊娠期健康女性,均应用外周血结核感染T细胞斑点试验进行检测,检测结果<24 SFCs/106PBMCs为阴性,≥24 SFCs/106PBMCs为阳性,采用敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比作为评价指标,评价其在妊娠期结核病诊断中的应用价值。结果在32例妊娠期健康女性中,阳性4例,阴性28例。在25例妊娠期结核病患者中,肺TB 17例,肺外TB 8例,阳性23例,阴性2例;10例细菌学确诊和15例临床诊断结核病的敏感性分别为100.0%(10/10)、86.7%(13/15)。总敏感性92.0%(23/25),特异性87.5%(28/32),阳性预测值85.2%(23/27),阴性预测值93.3%(28/30),阳性似然比7.36(92.0%/12.5%),阴性似然比0.09(8.0%/87.5%)。结论外周血结核感染T细胞斑点试验在妊娠期结核病诊断中具有较高的敏感性和特异性,可作为诊断妊娠期结核病的一种快速、有效的方法。

Objective To evaluate the clinical value of T cell spot test of tuberculosis infection （T-SPOT.TB） in the diagnosis of tuberculosis in pregnancy. Methods A retrospective analysis of 25 inpatients with tuberculosis in pregnancy and 32 healthy pregnant women was performed from May 2012 to December 2017, at Beijing Chest Hospital, Capital Medical University. The patients were diagnosed tuberculosis based on the bacteriology or clinical data. All subjects received T-SPOT.TB assay to detect the specific T cells in the peripheral blood mononuclear cells. The test result was negative if T-SPOT.TB 〈24 SFCs/106 PBMCs and positive if T-SPOT.TB ≥24 SFCs/106 PBMCs. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used as the evaluation targets, and discussed T-SPOT.TB applied value in the diagnosis of tuberculosis in pregnancy. Results Among 32 healthy pregnant women, 4 were positive and 28 were negative. In 25 tuberculosis cases during pregnancy, 17 were pulmonary tuberculosis and 8 were extra-pulmonary tuberculosis; 23 were positive and 2 were negative. The sensitivity of T-SPOT.TB assay in the bacteriological diagnosis and clinical diagnosis were 100.0% （10/10） and 86.7% （13/15）, respectively. The total sensitivity and specificity of T-SPOT.TB assay in the diagnosis of tuberculosis in pregnancy were 92.0% （23/25） and 87.5% （28/32） respectively; with positive predictive value of 85.2% （23/27） and negative predictive value of 93.3% （28/30）; positive likelihood ratio and negative likelihood ratio were 7.36 （92.0%/12.5%） and 0.09 （8.0%/87.5%）. Conclusion T-SPOT.TB has high sensitivity and specificity, and can be diagnosed as a rapid and effective method in the diagnosis of tuberculosis in pregnancy.