活动性肺结核高分辨CT的影像特点及联合T-SPOT.TB和TB-Ab诊断价值分析

Imaging Features of High-resolution CT with Active Tuberculosis and Diagnostic Value of Their Combination with T-SPOT.TB and TB-Ab

目的:观察活动性肺结核高分辨CT影像学特点及联合T细胞斑点试验(T-SPOT.TB)和血清结核抗体(TB-Ab)检测的诊断价值。方法:选择2016年1月至2019年7月医院收治的疑诊活动性肺结核198例,入院后均接受高分辨CT检查、T-SPOT.TB及TB-Ab检查,总结活动性肺结核高分辨CT特点及T-SPOT.TB、TB-Ab联合诊断效能。结果:112例确诊活动性肺结核患者中见小叶中心结节、树芽征各92例(82.14%),支气管管壁增厚82例(73.21%),肺实变86例(76.79%),空洞征82例(73.21%),线状影81例(72.32%),液体支气管征81例(72.32%),磨玻璃征64例(57.14%)。高分辨CT诊断活动性肺结核敏感度、特异度、准确率分别为77.67%、82.56%和79.80%,阳性预测值与阴性预测值分别为85.29%和73.96%;T-SPOT.TB诊断敏感度、特异度、准确率分别为95.54%、90.70%和93.43%,阳性预测值与阴性预测值分别为93.04%和93.98%;TB-Ab诊断敏感度、特异度、准确率分别为28.57%、82.56%和52.02%,阳性预测值与阴性预测值分别为68.09%和44.10%;联合诊断敏感度、特异度、准确率分别为97.32%、95.35%和96.46%,阳性预测值与阴性预测值分别为96.46%和96.47%。结论:活动性肺结核高分辨CT特异性征象为小叶中心结节、树芽征、支气管管壁增厚、肺实变、空洞征等,有助于其诊断及识别。而T-SPOT.TB对活动性肺结核诊断效能最高,对其无法确诊病例可辅助高分辨CT及TB-Ab检查,提高活动性肺结核检出率。

Objective: To observe imaging features of high-resolution CT(HRCT) in patients with active tuberculosis and diagnostic value of their combination with T cell spot test-tuberculosis(T-SPOT.TB) and serum tuberculosis antibody(TB-Ab). Methods: During the period from January 2016 to July 2019, 198 patients with suspected active tuberculosis who were admitted to the hospital were enrolled. After admission, all underwent HRCT, T-SPOT.TB and TB-Ab examination. HRCT features of active tuberculosis and diagnostic efficiency of their combination with T-SPOT.TB and TB-Ab were summarized. Results: HRCT images of the 112 patients diagnosed with active tuberculosis showed lobular central nodules and tree-in-bud signs in 92 cases(82.14%), thickened bronchial walls in 82 cases(73.21%), lung consolidation in 86 cases(76.79%), cavity signs in 82 cases(73.21%), linear shadow in 81 cases(72.32%), liquid bronchial signs in 81 cases(72.32%) and ground-glass opacity in 64 cases(57.14%). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HRCT for diagnosis of active tuberculosis were 77.67%, 82.56%, 79.80%, 85.29% and 73.96%, respectively. The above 5 indexes of T-SPOT.TB and TB-Ab were(95.54%, 90.70%, 93.43%, 93.04%, 93.98%) and(28.57%, 82.56%, 52.02%, 68.09%, 44.10%), respectively. The above 5 indexes of combined diagnosis were 97.32%, 95.35%, 96.46%, 96.46% and 96.47%, respectively. Conclusion: HRCT specific signs of active tuberculosis include lobular central nodules, tree-in-bud sign, bronchial wall thickening, lung consolidation and cavity signs, which are conducive to their diagnosis and identification. The diagnostic efficiency of T-SPOT.TB is the highest for active tuberculosis. For cases that cannot be confirmed, T-SPOT.TB can be combined with HRCT and TB-Ab, so as to increase detection rate of active tuberculosis.