结核感染T细胞斑点试验在肺结核诊断中的价值

Value of T-SPOT in the diagnosis of pulmonary tuberculosis

目的研究结核感染T细胞斑点试验(T-SPOT)在临床诊断肺结核中的价值。方法回顾性分析2016年6月至2017年3月长沙市中心医院肺科医院住院患者中同时完善了T-SPOT检测和痰菌检测(包括痰抗酸染色和痰分枝杆菌培养)的286例疑似肺结核患者的临床资料,经临床证实为肺结核者187例,评价两种检测方法在临床诊断肺结核中的特异度、敏感度、阴性预测值及阳性预测值,同时分析T-SPOT检测假阴性病例的临床特点,推测导致其假阴性的可能相关危险因素。结果T-SPOT检测在肺结核临床诊断中的敏感度(85.03%)、阴性预测值(75.65%)高于痰菌检测(54.55%、51.98%),而T-SPOT检测在肺结核临床诊断中的特异度(87.88%)、阳性预测值(92.98%)则低于痰菌检测(92.93%、93.58%),其中敏感度、特异度及阴性预测值比较差异有统计学意义(P<0.05)。基础疾病状态(如恶性肿瘤、人类免疫缺陷病毒感染、糖尿病、结缔组织病、器官移植等)可能与T-SPOT检测假阴性结果存在一定的相关性。结论T-SPOT检测在肺结核的临床诊断上有较好的应用价值,但其检测结果可能受某些临床因素影响,需综合分析。

Objective To investigate the value of T cell enzyme-linked immunospot tuberculous test(T-SPOT)in the clinical diagnosis of pulmonary tuberculosis.Methods The clinical data of 286 suspected pulmonary tuberculosis patients,who experienced T-SPOT test and sputum bacteria test(including sputum acid fast stain and mycobacterium culture)in Plumonary Hospital of Changsha Central Hospital from June 2016 to March 2017 were retrospectively analyzed.Of them,187 cases of pulmonary tuberculosis were clinically confirmed.The specificity,sensitivity,negative predictive value and positive predictive value of two detection methods in clinical diagnosis of pulmonary tuberculosis were evaluated.And the clinical characteristics of T-SPOT of false negative cases were analyzed in order to speculate on the possible risk factors leading to the false negative.Results The sensitivity(85.03%)and negative predictive value(75.65%)of T-SPOT were higher than those of sputum bacteria test(54.55%,51.98%)in clinical diagnosis of pulmonary tuberculosis,but the specificity(87.88%)and positive predictive value(92.98%)of T-SPOT were lower than those of sputum bacteria test(92.93%,93.58%),and sensitivity,specificity and negative predictive value were statistically different between the two methods(P<0.05).The underlying disease status(such as malignancy,human immunodeficiency virus infection,diabetes,connective tissue disease and organ transplantation)may be correlated with false negative results of T-SPOT.Conclusions T-SPOT has good application values in the clinical diagnosis of pulmonary tuberculosis,of which results may be affected by some clinical factors and need to be analyzed synthetically.