脑脊液与外周血T-SPOT.TB对结核性脑膜炎诊断价值的比较

A comparative study of the diagnostic value of T-SPOT.TB in cerebrospinal fluid and peripheral blood for tuberculous meningitis

目的评价脑脊液T-SPOT.TB对结核性脑膜炎的诊断价值。方法选取2012年1月~2016年6月河北省胸科医院结核内科收治的疑诊为结核性脑膜炎的147例患者,同时进行脑脊液及外周血的T-SPOT.TB,依据患者的最终诊断,将遴选的133例分为结核性脑膜炎组和非结核性脑膜炎组,比较脑脊液及外周血的T-SPOT.TB的阳性率与阴性率。结果所选患者中,结核性脑膜炎76例,非结核性脑膜炎57例。外周血T-SPOT.TB的敏感性为77.63%,与脑脊液的63.16%比较,差异无统计学意义(P>0.05);脑脊液T-SPOT.TB的特异性为98.25%,高于外周血的84.21%,差异有统计学意义(P<0.05);脑脊液的T-SPOT.TB的阳性预测值为97.96%,高于外周血的86.76%,差异有统计学意义(P<0.05);外周血的T-SPOT.TB的阴性预测值为73.85%,与脑脊液的66.67%比较,差异无统计学意义(P>0.05)。当脑脊液的T-SPOT.TB的cut-off值在96 SFCs/106PEMC时,诊断结核性脑膜炎的敏感性为90.79%,特异性为98.25%,阳性预测值为98.57%,阴性预测值为88.89%,ROC曲线下面积为0.993(95%CI:0.982~1.000)。结论与外周血的T-SPOT.TB比较,脑脊液的T-SPOT.TB可大幅提高对结核性脑膜炎的特异性和阳性预测值,可显著提高结核性脑膜炎的诊断水平。

Objective To evaluate the diagnostic value of T-SPOT.TB in cerebrospinal fluid for tuberculous meningitis.Methods A total of 147 inpatients of suspected tuberculous meningitis in the Department of TB Medicine of Hebei Chest Hospital from January 2012 to June 2016 were selected.Based on final diagnosis,133 patients were divided into two groups：tuberculous meningitis group and non tuberculous meningitis group.The positive and the negative rates of T-SPOT.TB in cerebrospinal fluid and peripheral blood were compared.Results Among the patients,there were 76 cases of diagnosed tuberculous meningitis,and 57 cases of non tuberculous meningitis.The sensitivity of T-SPOT.TB in peripheral blood was 77.63%,compared with 63.16% of T-SPOT.TB in cerebrospinal fluid,there was no statistically significant difference（P〈0.05）.The specificity of T-SPOT.TB in cerebrospinal fluid was 98.25%,significantly higher than 84.21% of T-SPOT.TB in peripheral blood,the difference was statistically significant（P 0.05）.The positive predictive value of T-SPOT.TB in cerebrospinal fluid was 97.96%,higher than 86.76% of T-SPOT.TB in peripheral blood,the difference was statistically significant（P 0.05）.The negative predictive value of T-SPOT.TB in peripheral blood was 73.85%,compared with 66.67% of T-SPOT.TB in cerebrospinal fluid,there was no statistically significant difference between the results（P 0.05）.Taking96 SFCs/106 PEMC as the cut-off value,the sensitivity,specificity,PPV,NPV and AUROC of T-SPOT.TB in cerebrospinal fluid in diagnosis of tuberculous meningitis were 90.79%,98.25%,98.57%,88.89%and 0.993（95% CI：0.982-1.000）,respectively.Conclusion Compared with T-SPOT.TB in peripheral blood,the T-SPOT.TB in cerebrospinal fluid can significantly improve the specificity and PPV,and accurate diagnosis level of tuberculous meningitis.