结核感染T细胞斑点试验与结核菌素试验在诊断儿童结核感染中的价值比较

Comparison of T-SPOT.TB assay and TST in the diagnosis of pediatric tuberculosis

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)与结核菌素皮肤试验(tuberculin skin test, TST)在儿童结核感染中的诊断价值。方法选择2015年1月至2019年3月浙江大学金华医院确诊的69例结核感染患儿及同期187例非结核感染患儿,分别比较T-SPOT.TB以及TST两种检测方法的诊断敏感性、特异性、AUC,并分析影响因素。结果 TSPOT.TB及TST在诊断结核感染患儿中的敏感性分别为97.1%、40.6%;在非结核感染患儿的诊断特异性分别为98.9%、93.0%;在诊断肺结核中,诊断敏感性分别为100.0%、58.7%;在单纯肺外结核的患儿中,诊断的敏感性分别为91.3%、39.1%;在免疫功能受损的结核感染患儿中,诊断的敏感性分别为88.9%和33.3%,差异均有统计学意义(P <0.05)。TSPOT.TB在诊断结核感染的AUC为0.98,TST的AUC为0.69。结论与TST相比,T-SPOT.TB在诊断结核感染患儿特别是免疫受损结核感染患儿中敏感性、特异性更高,能减少结核病的漏诊和误诊,可作为临床早期诊断儿童结核感染的有效检查手段。

Objective To evaluate the value of T-SPOT.TB assay(T-SPOT.TB) and tuberculin skin test(TST) in the diagnosis of pediatric tuberculosis. Methods A retrospective analysis of 69 cases of tuberculosis and 187 cases of non-tuberculosis-infected children in Jinhua Hospital of Zhejiang University from January 2015 to March 2019 was conducted. The sensitivity, the specificity, and the area under the curve(AUC) of the two detection methods were calculated respectively. Results The sensitivity of T-SPOT.TB and TST in the tuberculosis group was 97.1% and 40.6%, respectively;in the control group, the specificity was 98.9% and 93.0%, respectively. The sensitivity of T-SPOT.TB and TST was 100.0% and 58.7% in the pulmonary tuberculosis group, the sensitivity of T-SPOT.TB and TST was 91.3% and 39.1% in the extrapulmonary tuberculosis group. The sensitivity of T-SPOT.TB and TST was 88.9% and 33.3% in the patients with impaired immune function. There was significant difference(all P<0.05). AUC of T-SPOT.TB was 0.98, AUC of TST was 0.69. Conclusions Compared with TST, T-SPOT.TB is more sensitive and specific in the diagnosis of the children with tuberculosis infection, especially in the children with immunocompromised tuberculosis infection. T-SPOT.TB can reduce the rate of missed diagnosis and misdiagnosis of tuberculosis, and can be used as an effective mean of early clinical diagnosis of the children with tuberculosis infection.