三种实验方法检测胸腔积液对结核性胸膜炎的诊断价值分析

Diagnostic Value of Three Detection Methods of Hydrothorax for Tuberculous Pleurisy

目的探讨GeneXpert MTB/RIF实验、结核感染T细胞斑点试验(T-SPOT.TB)以及结核分枝杆菌液体培养在结核性胸膜炎诊断中的价值。方法选取临床已经确诊结核性胸膜炎的患者142例和非结核性胸膜炎患者51例,对其胸腔积液样本分别进行GeneXpert MTB/RIF检测、T-SPOT.TB以及结核分枝杆菌培养,分析比较三种方法并联和串联对结核性胸膜炎的诊断价值。结果结核性胸膜炎患者T-SPOT.TB的阳性率显著高于其他两种方法。GeneXpert MTB/RIF检测、T-SPOT.TB以及结核分枝杆菌培养的敏感度分别为16.9%,81.0%和24.6%,特异度分别为98.0%,33.3%和86.3%,其中T-SPOT.TB试验的敏感度最高,特异度最小。三种方法串联后形成的四种不同方案的敏感度均低于19%,特异度均高于90%。三种方法并联后形成的四种不同方案的敏感度存在差异,其中GeneXpert MTB/RIF检测与结核培养试验并联方案的敏感度为29.6%,显著低于其他三种方案,其特异度为86.3%,显著高于其他三种方案。结论在结核性胸膜炎诊断中,T-SPOT.TB试验具有较高的敏感度,而GeneXpert MTB/RIF检测以及结核分枝杆菌培养具有较高的特异度;三者不同串联方案均具有很高的特异度;并联方案中,GeneXpert MTB/RIF检测与结核培养试验并联的诊断特异度最高,对通过胸腔积液诊断结核性胸膜炎提供重要参考价值。

Objective To investigate the value of GeneXpert MTB/RIF test,T cell spot test(T-SPOT.TB) and liquid culture of Mycobacterium tuberculosis in the diagnosis of tuberculous pleurisy.Methods 142 patients who were clinically diagnosed as tuberculous pleurisy and 51 patients who were clinically diagnosed as non-tuberculous pleurisy were selected,the pleural fluid samples were tested by GeneXpert MTB/RIF,T-SPOT.TB and Mycobacterium tuberculosis,respectively.Analyzed and compared the diagnostic value of three methods in parallel and in series for tuberculous pleurisy.Results The positive rate of T-SPOT.TB in patients with tuberculous pleurisy was significantly higher than the other two methods.The sensitivity of GeneXpert MTB/RIF test,T-SPOT.TB and Mycobacterium tuberculosis culture were 16.9%,81.0% and 24.6%,respectively,and the specificities were 98.0%,33.3% and 86.3%,respectively,of which T-SPOT.TB test the highest sensitivity and the lowest specificity.The sensitivity of the four different schemes formed by the three methods in series was less than 19%,and the specificity was higher than 90%.The sensitivity of the four different schemes formed by the parallel connection of the three methods was different.The sensitivity of the scheme of GeneXpert MTB/RIF in parallel with the tuberculosis culture test was 29.6%,which was significantly lower than the other three schemes.The degree was 86.3%,which was significantly higher than the other three programs.Conclusion In the diagnosis of tuberculous pleurisy,the T-SPOT.TB test has higher sensitivity,while the GeneXpert MTB/RIF test and Mycobacterium tuberculosis culture have higher specificity.The three different tandem schemes have high specificity.GeneXpert MTB/RIF detection and tuberculosis in a parallel scheme,which provides an important reference value for the diagnosis of tuberculous pleurisy by pleural effusion.