结核感染T细胞斑点试验假阴性影响因素回归分析

Logistic Analysis on Risk Factors Related to False Negative T-SPOT.TB Results

目的探讨结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)在结核病患者中出现假阴性结果的独立影响因素。方法对2016年1月～2017年9月河南省胸科医院和河南省人民医院诊治的结核病患者477例进行回顾性分析,按T-SPOT.TB结果分为假阴性组(224例)和阳性组(253例)。采用SPSS 19.0统计学软件对两组临床资料进行统计分析,应用Logistic回归分析对假阴性的影响因素进行分析。结果性别、红细胞沉降率、白细胞计数、红细胞计数、空腹血糖、白蛋白、超敏C反应蛋白、结核病灶的部位,这些因素对影响T-SPOT.TB的假阴性结果差异无统计学意义。而年龄(OR=1.045,95%CI:1.031～1.059)、淋巴细胞计数(OR=0.242,95%CI:0.164～0.356)、单核细胞计数(OR=0.254,95%CI:0.134～0.480)是T-SPOT.TB出现假阴性的独立影响因素。结论对于高龄,或有较低的淋巴细胞数、单核细胞计数的疑似结核病患者,若出现T-SPOT.TB阴性的结果,需结合临床进行综合判断。

Objective To investigate the dependent risk factors for false negative T-SPOT.TB results.Methods This retrospective study was performed in 477 tuberculous patients with determinate T-SPOT.TB tests,who are admitted to Henan Provincial Chest Hospital and Henan Province People′s Hospital from January 2016 to September 2017.The subjects were divided into two subgroups according to the T-SPOT.TB results,including false-negative(n=224)and true-positive(n=253)groups.The univariate and multivariate Logistic regression analysis were used to analyze the relation between risk factors and false-negative T-SPOT.TB results.The criterion for significance was set as P<0.05.Results Logistic analysis showed that gender,blood sedimentation,white blood cell count,red blood cell count,fasting blood glucose,albumin,hypersensitivity C reaction protein,and the site of tuberculosis had no statistical significance to the false negative results of T-SPOT.TB.Meanwhile the increased age[odds radio(OR)=1.045,95%confidence interval(CI):1.031-1.059],lymphocytopenia(OR=0.242,95%CI:0.164-0.356),monocytopenia(OR=0.254,95%CI:0.134-0.480)were dependent risk factors for false negative T-SPOT.TB results in tuberculous patients.Conclusion Careful interpretation of negative T-SPOT.TB is necessary in suspect tuberculous patients who are older or lymphocytopenia,monocytopenia.