T细胞酶联免疫斑点试验辅助诊断儿童结核病的应用价值

Diagnostic performance of T-SPOT test for pediatric tuberculosis

目的探讨T细胞酶联免疫斑点试验(T-SPOT)辅助诊断儿童结核病(TB)的应用价值。方法回顾性分析简阳市人民医院2014年6月至2017年5月诊治的确诊TB患儿67例和排除TB患儿71例的T-SPOT、结核菌素纯蛋白衍生物(PPD)检测结果,比较两种检查的诊断效能和一致性,以及联合检查的诊断效能。结果T-SPOT的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、Youden指数分别为88.1%、94.4%、93.7%、89.3%、15.6、0.13、0.83,PPD分别为68.7%、74.6%、71.9%、71.6%、2.71、0.42、0.43。T-SPOT的灵敏度、特异度、阳性预测值、阴性预测值均高于PPD,差异均有统计学意义(χ^2=7.44、10.54、10.51、7.45,均P<0.01)。T-SPOT对肺内和肺外结核诊断的阳性率分别为90.9%、82.6%,差异无统计学意义(P>0.05)。>4~18岁组T-SPOT的阳性率高于0~4岁组(95.1%比76.2%,χ^2=5.01,P<0.05)。0~4岁组T-SPOT和PPD的诊断一致性高于>4~18岁组(kappa值0.78比0.23)。两种方法联合试验的灵敏度为94.2%,与单一T-SPOT试验差异无统计学意义(P>0.05)。结论T-SPOT辅助诊断儿童TB总体优于PPD,在>4~18岁组优势明显。与单用T-SPOT比较,尚不能认为两种方法联用可提高灵敏度。

Objective To investigate the diagnostic performance of T-SPOT test for pediatric tuberculosis(TB).Methods The results of T-SPOT and PPD in 67 TB children and 71 TB-excluded children that diagnosed and treated in the People's Hospital of Jianyang from June 2014 to May 2017 were retrospectively analyzed.The diagnostic efficacy and consistency of the two tests,and the diagnostic efficacy of combined examination were evaluated.Results The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,Youden′s index of T-SPOT were 88.1%,94.4%,93.7%,89.3%,15.6,0.13,0.83,respectively.While the above parameters of PPD were 68.7%,74.6%,71.9%,71.6%,2.71,0.42,0.43,respectively.T-SPOT had higher sensitivity,specificity,positive predictive value,negative predictive value compared with PPD,and the differences were statistically significant(χ^2=7.44,10.54,10.51,7.45,all P<0.01).The positive rates of T-SPOT for pulmonary and extra-pulmonary TB were 90.9%and 82.6%,and the difference was not statistically significant(P>0.05).The positive rate of T-SPOT was higher in 5-18 years old group than that in 0-4 years old group(95.1%vs.76.2%,χ^2=5.01,P<0.05).The latter group held a diagnostic concordance greater than the former(kappa value 0.78 vs.0.23).The sensitivity of combined tests had no statistically significant difference compared with T-SPOT alone(P>0.05).Conclusion T-SPOT outperformed PPD in diagnostic assistance of pediatric TB overall.The diagnostic superiority is noticeable in the>4-18 years old other than the 0-4 years old.Compared with T-SPOT alone,combined tests should not be regarded to have increased sensitivity.