T-SPOT.TB检测在脊柱结核诊断及疗效评估中的价值

Value of T-SPOT.TB testing in diagnosis and curative effect evaluation of spinal tuberculosis

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)检测在脊柱结核前期诊断和治疗后效果评价中的应用价值。方法收集2012年1月至2016年12月该院收治的疑似脊柱结核患者98例,分别行TSPOT.TB、结核菌素(PPD)试验和抗结核抗体检测,比较3种辅助检查方法的阳性预测值、阴性预测值、特异度、敏感度;其中最终明确为脊柱结核的患者62例,从其治疗开始跟踪随访1、3、6、12个月,监测其T-SPOT.TB的变化情况。结果 T-SPOT.TB、抗结核抗体、PPD试验的敏感度、特异度、阳性预测值和阴性预测值分别为93.5%、91.7%、95.1%、89.2%,61.3%、72.2%、79.2%、52.0%和70.9%、58.3%、74.6%、53.8%。TSPOT.TB检测在敏感度、特异度、阳性预测值和阴性预测值方面均优于抗结核抗体和PPD试验,差异有统计学意义(P<0.05)。抗结核治疗后的1、3、6、12个月,T-SPOT.TB检测结果转阴例数仅占临床症状缓解病例数的0、8.3%、22.0%、51.3%。结论 T-SPOT.TB检测拥有良好的特异度、敏感度、阳性预测值和阴性预测值,在脊柱结核的诊断中具有重要意义,但其并不是评估脊柱结核治疗效果的良好指标。

Objective To explore the application value of T-SPOT.TB testing in the early stage diagnosis and curative effect evaluation after treatment of spinal tuberculosis （TB）. Methods Ninety-eight patients with suspected spinal TB treated in this hospital from January 2012 to December 2016 were collected and conducted T-SPOT.TB testing,tuberculin test （PPD） and anti-TB antibody detection respectively.The positive predictive value,negative predictive value,specificity and sensitivity were compared among these three auxiliary examination methods.Among them,62 cases were finally diagnosed as spinal TB.The follow up lasted for 1,3,6 12 months from the treatment beginning and the change of T-SPOT.TB testing results was monitored. Results The sensitivity,specificity,positive predicting value and negative predicting value of T-SPOT.TB test,anti-TB antibody testing and PPD were 93.5%,91.7%,95.1%,89.2%;61.3%,72.2%,79.2%,52.0%;70.9%, 58.3 %,74.6% and 53.8% respectively.T-SPOT.TB was superior to anti-tuberculosis antibody testing and PPD test in the aspects of sensitivity,specificity,positive predicting value and negative predicting value,the differences were statistically significant （ P 〈0.05）.The case number of T-SPOT.TB test results converting to negative at 1,3,6,12 months after anti-TB therapy only accounted for 0,8.3%,22.0% and 51.3% of cases number of clinical remission respectively. Conclusion T-SPOT.TB testing has good specificity,sensitivity,positive predicting value and negative predicting value,has an important significance in the diagnosis of spinal TB.But it is not a good indicator for evaluating the therapeutic effect of spinal TB.