结核感染T细胞斑点试验、Xpert Mtb/RIF检测技术在老年肺结核中的诊断价值

Diagnostic value of T-SPOT.TB and Xpert Mtb/RIF detection technique in senile pulmonary tuberculosis

目的评价结核感染T细胞斑点试验(T-SPOT)、结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(Xpert Mtb/RIF)在老年肺结核中的诊断价值。方法纳入2016年9月至2016年12月在广州市胸科医院住院的老年可疑肺结核患者81例。采集痰标本同时送检抗酸染色涂片、金标准培养并行金标准比例法传统药敏试验、荧光定量PCR和Xpert Mtb/RIF检测,并抽血送检血T-SPOT。以临床最终诊断结果为金标准,分析各种方法诊断老年肺结核的敏感度、特异度。结果 81例老年可疑肺结核患者中,最终诊断肺结核患者44例,非结核肺病患者37例。以临床最终诊断结果为金标准^([10]),血T-SPOT、痰Xpert MTB/RIF、痰荧光定量PCR、痰涂片和痰培养诊断老年肺结核的灵敏度分别为93. 18%、45. 45%、42. 22%、22. 73%和50. 00%;特异度分别为63. 89%、100%、94. 59%、83. 78%和81. 08%。结论血T-SPOT在诊断老年肺结核中有较高的灵敏度,但特异度稍差;痰Xpret MTB/RIF较痰涂片灵敏度提高,特异度达100%。

Objective To evaluate the diagnostic value of T-SPOT.TB and Xpert Mtb/RIF detection technique in elderly pulmonary tuberculosis.Methods 81 cases of elderly suspected pulmonary tuberculosis patients admitted to Guangzhou Chest Hospital from September 2016 to December 2016 were included.Sputum samples were collected simultaneously with anti-acid stain smear,traditional drug susceptibility test with gold standard culture and gold standard ratio method.Fluorescence quantitative PCR and Xpert Mtb/RIF was also used for detection.Blood was extracted for T-SPOT detection.The sensitivity and specificity of the diagnosis of senile pulmonary tuberculosis were analyzed by means of the clinical final diagnosis.Results Among the 81 elderly patients with suspected pulmonary tuberculosis,44 cases were diagnosed as pulmonary TB patients and 37 cases were non-TB patients.Clinical final diagnosis being the gold standard,the sensitivity of blood T-SPOT,sputum Xpert MTB/RIF,sputum fluorescence quantitative PCR,sputum smear and sputum culture in diagnosing senile pulmonary tuberculosis were 93.18%,45.45%,42.22%,22.73%and 50.00% respectively.The specificity was 63.89%,100%,94.59%,83.78%and 81.08%respectively.Conclusion Blood T-SPOT has high sensitivity in the diagnosis of senile pulmonary tuberculosis,but its specificity is low.Sputum Xpret MTB/RIF have more sensitive than sputum smear.The specificity of sputum Xpert MTB/RIF is 100%.