TB-DNA、T-SPOT.TB和TB-Ab平行检测在肺结核诊断中的应用价值

Application values of parallel detection of TB-DNA,T-SPOT.TB and TB-Ab in diagnosis of pulmonary tuberculosis

目的评价结核分枝杆菌脱氧核糖核酸(TB-DNA)检测、结核感染T细胞酶联免疫斑点试验(T-SPOT.TB)和结核抗体(TB-Ab)检测3种方法在肺结核诊断中的应用价值。方法收集2019年1-12月商洛某三甲医院收治的245例疑似肺结核患者的一般资料,根据最终诊断结果分为肺结核患者组(试验组)和非结核病患者组(对照组)。比较TB-DNA、TB-Ab和T-SPOT.TB 3种方法平行检测结果在两组中的差异,并分析TB-DNA、TB-Ab和T-SPOT.TB在肺结核诊断中的应用价值。结果试验组的TB-DNA、T-SPOT.TB和TB-Ab的阳性率均高于对照组,差异均有统计学意义(P<0.05)。运用受试者工作特征曲线(ROC曲线)分析,T-SPOT.TB抗原A、T-SPOT.TB抗原B、TB-DNA、TB-Ab的ROC曲线下面积分别是0.908、0.881、0.677、0.649。这3种方法在肺结核诊断中以TB-DNA的特异度(97.14%)最高,T-SPOT.TB的灵敏度(89.14%)最高。T-SPOT.TB的诊断符合率高于TB-DNA和TB-Ab,差异均有统计学意义(P<0.05),TB-DNA和TB-Ab的诊断符合率差异无统计学意义(P>0.05)。联合检测可以提高灵敏度,T-SPOT.TB联合TB-DNA具有最高的诊断符合率。结论T-SPOT.TB具有较高的灵敏度、特异度和诊断符合率,在肺结核诊断中具有较高价值,科学地选择组合项目检测可以提高诊断符合率。

Objective To evaluate the application value of TB-DNA,T-SPOT.TB and TB-Ab methods in pulmonary tuberculosis diagnosis.Methods The general data in 245 cases of suspected pulmonary tuberculosis treated in a class 3A hospital of Shangluo from January to December 2019 were collected.According to the final diagnosis results,the patients were divided into the pulmonary tuberculosis patients group(experimental group)and non-pulmonary tuberculosis patients group(control group).The differences in the parallel detection results of TB-DNA,TB-Ab and T-SPOT.TB were compared between the two groups,and the application values of TB-DNA,TB-Ab and T-SPOT.TB in pulmonary tuberculosis diagnosis were analyzed.Results The positive rates of TB-DNA,T-SPOT.TB and TB-Ab in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).In the analysis of the receiver operating characteristic(ROC)curve,the area under the ROC curve of T-SPOT.TB antigen A,T-SPOT.TB antigen B,TB-DNA and TB-AB were 0.908,0.881,0.677 and 0.649 respectively.The specificity of TB-DNA for diagnosing pulmonary tuberculosis among 3 methods was the highest(97.14%)and the sensitivity of T-SPOT.TB was the highest(89.14%).The diagnostic coincidence rate of T-SPOT.TB was higher than that of TB-DNA and TB-AB,the differences were statistically significant(P<0.05),and the diagnostic coincidence rate of TB-DNA and TB-AB was not statistically significant(P>0.05).The combined detection could increase the sensitivity,and T-SPOT.TB combined with TB-DNA had the highest diagnostic coincidence rate.Conclusion T-SPOT.TB has the high sensitivity,specificity and diagnostic coincidence rate,and has the higher value in pulmonary tuberculosis diagnosis.Scientific selection of combination items test can increase the diagnostic coincidence rate.