T-SPOT.TB、TB-LAMP、TB-DNA定量对肺结核的诊断价值分析

Diagnostic value of T-SPOT.TB,SAT-TB and TB-DNA quantification for tuberculosis

目的:探讨γ干扰素释放试验(T-SPOT.TB)、实时荧光核酸恒温扩增技术(SAT-TB)、肺结核核酸(TB-DNA)定量对肺结核的诊断价值。方法:选取2018年1月~2020年6月本院的疑似肺结核患者153例,经痰培养确诊后分为肺结核组(n=78)与非肺结核组(n=75),对所有患者均行T-SPOT.TB、SAT-TB、TB-DNA定量检测,观察比较三种检测方法间单独诊断与联合诊断肺结核的敏感度、特异度、准确度、kappa值。结果:⑴T-SPOT.TB、SAT-TB、TB-DNA定量等三种检测方法单独诊断肺结核的敏感度%分别为93.6、83.3、71.8,特异度%分别为96.0、96.0、97.3,准确度%分别为94.1、83.7、70.6,差异均具有统计学意义。其中,T-SPOT.TB诊断肺结核的敏感度、特异度、准确度均大于SAT-TB、TB-DNA定量检测,差异均具有统计学意义。⑵三种联合检测方法的诊断敏感度、特异度、准确度仅略高于T-SPOT.TB的单独应用。三种联合检测方法间无统计学差异。结论:T-SPOT.TB对肺结核的诊断价值远大于SAT-TB、TB-DNA定量检测,甚至和联合检测不相上下,有望成为替代痰培养的检测方法,值得临床进一步推广应用。

Objective To explore the diagnostic value of tuberculous bacillus-interferon release test(T-SPOT.TB),real-time fluorescent nucleic acid thermostatic amplification technology(SAT-TB)and tuberculosis bacillus-DNA(TB-DNA)quantification for tuberculosis.Methods A total of 153 patients with suspected tuberculosis in the hospital from January 2018 to June 2020 were enrolled.After confirmed by sputum culture,they were divided into tuberculosis group(n=78)and non-tuberculosis group(n=75).All underwent quantitative detection of T-SPOT.TB,SAT-TB and TB-DNA.The sensitivity,specificity,accuracy and kappa value of the three alone and their combination for the diagnosis of tuberculosis were observed and compared.Results(1)The sensitivity,specificity and accuracy rates of T-SPOT.TB,SAT-TB and TB-DNA alone for the diagnosis of tuberculosis were(93.6%,83.3%,71.8%),(96.0%,96.0%,97.3%)and(94.1%,83.7%,70.6%),respectively.And the differences were statistically significant.The sensitivity,specificity and accuracy rates of T-SPOT.TB were greater than those of SAT-TB and TB-DNA alone.(2)The sensitivity,specificity and accuracy rates of their combined diagnosis were slightly higher than those of T-SPOT.TB.And the difference was not statistically significant among the three methods.Conclusion The diagnostic value of T-SPOT.TB for tuberculosis is much greater than that of SAT-TB and TB-DNA,which is expected to be a alternative method of sputum culture.