T-SPOT.TB技术在菌阴肺结核中的诊断价值

Diagnostic value of T-SPOT. TB in mycobacterium tuberculosis

目的:探讨结核感染T细胞斑点试验(T-SPOT. TB)对痰液抗酸杆菌涂片阴性肺结核的诊断价值。方法:调查2016年6月至2017年8月中国医科大学塔城医院收治的痰液抗酸杆菌涂片阴性肺结核患者156例为观察组,肺炎患者144例为对照组,比较两组患者T-SPOT. TB、结核抗体和血沉。结果:两组患者T-SPOT. TB和结核抗体组间比较差异均有统计学意义(P <0. 001),两组患者血沉组间比较差异无统计学意义(P> 0. 05);痰液抗酸杆菌涂片阴性肺结核患者,T-SPOT. TB和结核抗体的灵敏度及特异度分别是0. 955,0. 896和0. 492,0. 877; SPOT. TB的曲线下面积(AUC)是0. 925,结核抗体的AUC是0. 684,两者差异有统计学意义(Z=3. 879,P <0. 001)。T-SPOT. TB与logistic回归模型的ROC曲线比较差异有统计学意义(Z=3. 621,P=0. 009)。结论:T-SPOT. TB在诊断菌阴肺结核有着重要的诊断价值。

Objective： To evaluate the value of T-SPOT. TB assays in the diagnosis of tuberculosis（ TB） patients with sputum anti-acid bacillus smear negative. Methods： 156 TB patients with sputum anti-acid bacillus smear negative admitted to Tacheng Hospital of China Medical University from June 2016 to August 2017 were enrolled in the observation group. 144 patients with pneumonia were recruited in the control group.T-SPOT. TB,TB antibody and erythrocyto sedimentation rate（ ESR） were compared between TB patients with sputum anti-acid bacillus smear negative and pneumonia patients. Results： There was significant difference in T-SPOT. TB and TB antibody between TB patients with sputum anti-acid bacillus smear negative and pneumonia patients（ P 〈 0. 001,P 〈 0. 001,respectively）. Whereas,there was no significant difference in ESR between TB patients with sputum anti-acid bacillus smear negative and pneumonia patients（ P = 0. 521 〉 0. 05）. The sensitivity and specificity of the TSPOT. TB and TB antibody in diagnosis of TB patients with sputum anti-acid bacillus smear negative was 0. 955,0. 896 and 0. 492,0. 877,respectively. There was significant difference in area under the curve（ AUC） of T-SPOT. TB and that of TB antibody（ Z = 3. 879,P 〈0. 001）. There was significant difference in ROC curve of T-SPOT. TB and that of logistic regression（ Z = 3. 621,P = 0. 009 〈 0. 01）. Conclusion： T-SPOT. TB has important clinical value in the diagnosis of TB patients with sputum anti-acid bacillus smear negative.