胸腔镜胸膜活检、T-SPOT.TB试验单独及联合用于结核性胸膜炎的诊断价值

Value of pleural biopsy,T-SPOT.TB test alone and combined in the diagnosis of tuberculous pleurisy

目的探讨胸腔镜胸膜活检、外周血结核感染T细胞斑点试验(T-SPOT.TB)单独及联合用于结核性胸膜炎的诊断价值。方法纳入2014年1月至2017年1月我院呼吸内科收治的疑似结核性胸膜炎患者93例为研究对象,回顾性分析其诊断资料。所有患者均接受胸腔镜胸膜活检及外周血T-SPOT.TB试验,并以《临床诊疗指南:结核病分册》中相关标准为"金标准"诊断结核性胸膜炎,以此为依据,评价胸腔镜胸膜活检、T-SPOT.TB单独或联合诊断结核性胸膜炎的效能。结果胸腔镜胸膜活检与金标准检测结果缺乏一致性(Kappa=0.273,P=0.007);T-SPOT.TB实验与金标准检测结果一致性尚可(Kappa=0.590,P<0.001);联合检测于金标准检测结果一致性尚可(Kappa=0.588,P<0.001)。联合检测方案的诊断敏感度、阴性预测值明显高于单一方案,差异有统计学意义(P<0.05),且诊断准确率最高,为82.8%。结论胸腔镜胸膜活检、T-SPOT.TB单独诊断结核性胸膜炎的可靠性均有待提升;联合2种方案则有助于大幅提升诊断敏感度、阴性预测值,从而提升早期诊断效能。

Objective To evaluate the diagnostic value of pleural biopsy and T-SPOT. TB alone or combined in the diagnosis of tuberculous pleurisy. Methods 93 suspected tuberculous pleurisy patients from January 2014 to January 2017 were retrospectively analyzed. All patients received thoracoscopic pleural biopsy and peripheral blood TSPOT. TB test. According to Clinical Practice Guidelines： Tuberculosis,they were diagnosed with or without tuberculous pleurisy,in order to evaluate the diagnostic value of pleural biopsy and T-SPOT. TB alone or combined. Results The diagnosis results of thoracoscopic pleural biopsy had certain consistency with gold standard（ Kappa = 0. 273,P= 0. 007）. The diagnoses results of T-SPOT. TB test had certain consistency with gold standard（ Kappa = 0. 590,P〈0. 001）. The combined results had certain consistency with gold standard（ Kappa = 0. 588,P〈0. 001）. The diagnostic sensitivity and negative predictive value of the combined detection method were significantly higher than those of the single scheme（ P〈0. 05）,and the diagnostic accuracy was the highest,which was 82. 8%. Conclusion Thoracoscopic pleural biopsy and T-SPOT. TB diagnosis for tuberculous pleurisy both need to be improved. The combination of these 2 methods helps to significantly enhance the diagnostic sensitivity and negative predictive value,so as to enhance the effectiveness of early diagnosis.