菌阴性肺结核诊断评分系统联合血清抗脂阿拉伯甘露聚糖抗体对菌阴性肺结核的临床诊断价值

Clinical diagnostic value of diagnostic scoring system of bacteriological negative pulmonary tuberculosis combined with serum anti-lipoarabinomannan antibody for bacteriological negative pulmonary tuberculosis

目的探讨菌阴性肺结核诊断评分系统联合血清抗脂阿拉伯甘露聚糖(LAM)抗体诊断菌阴性肺结核的临床价值。方法将396例疑似菌阴性肺结核患者根据病理学诊断结果分为结核组(n=200)和非结核组(n=196),均进行菌阴性肺结核诊断评分系统评分及血清抗LAM抗体检测,绘制受试者工作特征(ROC)曲线分析菌阴性肺结核诊断评分系统、抗LAM抗体单独应用及二者联合应用诊断菌阴性肺结核的价值。结果菌阴性肺结核诊断评分系统单独诊断菌阴性肺结核的灵敏度为60.00%,特异度为95.92%,ROC曲线下面积为0.832;抗LAM抗体单独诊断菌阴性肺结核的灵敏度为69.00%,特异度为65.82%,ROC曲线下面积为0.779;菌阴性肺结核诊断评分系统联合抗LAM抗体诊断菌阴性肺结核的灵敏度为84.00%,特异度为86.22%,准确率为85.10%,ROC曲线下面积为0.906。菌阴性肺结核诊断评分系统和抗LAM抗体联合检测诊断菌阴性肺结核的灵敏度、特异度及ROC曲线下面积均高于二者单独诊断(均P<0.05)。结论菌阴性肺结核诊断评分系统联合血清抗LAM抗体可提高诊断菌阴性肺结核的灵敏度,并保持较高的特异度,对菌阴性肺结核的诊断有重要的临床价值。

Objective To explore the clinical value of the diagnostic scoring system of bacteriological negative pulmonary tuberculosis combined with serum anti-lipoarabinomannan(LAM)antibody in the diagnosis of bacteriological negative pulmonary tuberculosis.Methods A total of 396 patients with suspected bacteriological negative pulmonary tuberculosis were divided into tuberculosis group(n=200)and non-tuberculosis group(n=196)according to the pathological diagnosis findings,and the two groups undertook the scoring with the diagnostic scoring system of bacteriological negative pulmonary tuberculosis and serum anti-LAM antibody detection.The diagnostic values of the diagnostic scoring system of bacteriological negative pulmonary tuberculosis alone,anti-LAM antibody detection alone,and their combination for bacteriological negative pulmonary tuberculosis were analyzed by receiver operating characteristic(ROC)curve.Results For diagnosing bacteriological negative pulmonary tuberculosis,the sensitivity,specificity and area under ROC curve of the diagnostic scoring system of bacteriological negative pulmonary tuberculosis alone were 60.00%,95.92%and 0.832,respectively;the sensitivity,specificity and area under ROC curve of anti-LAM detection alone were 69.00%,65.82%and 0.779,respectively;the sensitivity,specificity,accuracy and area under ROC curve of the diagnostic scoring system of bacteriological negative pulmonary tuberculosis combined with anti-LAM antibody detection were 84.00%,86.22%,85.10%and 0.906,respectively.The diagnostic scoring system of bacteriological negative pulmonary tuberculosis combined with anti-LAM antibody detection had higher sensitively,specificity and area under ROC curve than either index for diagnosing bacteriological negative pulmonary tuberculosis(all P<0.05).Conclusion The diagnostic scoring system of bacteriological negative pulmonary tuberculosis combined with serum anti-LAM antibody detection can improve sensitivity and maintain a higher specificity for diagnosing bacteriological negative pulmonary tuberculosis,which has a significant clinical valve in the diagnosis of bacteriological negative pulmonary tuberculosis.