4种检测方法对结核病的诊断价值

Evaluate the Diagnostic Value of Four Test Methods for Tuberculosis

目的评估结核菌素(PPD)试验、结核感染T细胞斑点试验(T-SPOT.TB)、结核分枝杆菌抗体(TB-Ab)检测和抗酸染色涂片(AFS)4种检测方法在结核病诊断中的应用价值。方法选取2017年6月至2019年12月医院收治的198例结核病患者作为研究对象,另选取同期128例非结核病患者,比较PPD试验、T-SPOT.TB、TB-Ab检测和AFS 4种检测方法的灵敏度和特异度。结果198例确诊结核病患者中,PPD试验、T-SPOT.TB、TB-Ab检测和AFS的灵敏度分别为54.55%、83.33%、12.24%和12.12%;128例非结核病患者中,PPD试验、T-SPOT.TB、TB-Ab检测和AFS的特异度分别为78.13%、60.94%、92.19%和96.90%。T-SPOT.TB与其他3种检测方法相比,灵敏度最高,特异度最低;AFS与其他3种检测方法相比,特异度最高,灵敏度最低,差异均有统计学意义(P<0.05)。结论T-SPOT.TB与PPD试验、TB-Ab检测和AFS比较,具有简便、快速、灵敏度高等优点,是临床快速诊断结核病的有效检测方法,但由于特异度较低,需要与其他方法联合检测,以提高早期诊断结核病的价值。

Objective The clinical application value of four test methods in the diagnosis of tuberculosis were evaluated in this study.The four test methods were tuberculin purified protein derivative(PPD)test,tuberculosis T cell spot assay(T-SPOT.TB),mycobacterium tuberculosis antibody(TB-Ab)test and acid-fast stain smear(AFS).Methods 198 hospitalized patients with tuberculosis and 128 patients without tuberculosis from June 2017 to December 2019 were selected as the subjects and the sensitivity and specificity were compared among the four methods of PPD test,T-SPOT.TB,TB-Ab test and AFS.Results In terms of the 198 patients confirmed with tuberculosis,the sensitivity was 54.55%for PPD test,83.33%for T-SPOT.TB,12.24%for TB-Ab test and 12.12%for AFS.As far as the 128 patients without tuberculosis were concerned,the specificity was 78.13%for PPD test,60.94%for T-SPOT.TB,92.19%for TB-Ab test and 96.90%for AFS.Compared with the other three methods,T-SPOT.TB had highest sensitivity and lowest specificity,and the differences were statistically significant(P<0.05).Compared with the other three methods,AFS showed highest specificity and lowest sensitivity,and the differences were statistically significant(P<0.05).Conclusions Compared with PPD test,TB-Ab test and AFS,T-SPOT.TB had the advantages of convenience,speediness and high sensitivity in diagnosing tuberculosis.And it was thought to be an effective test method in diagnosing tuberculosis rapidly.Whereas,the specificity of T-SPOT.TB was relatively low and it was necessary to combine with the other test methods to increase the value of diagnosing tuberculosis at the early stage.