不同检测方法对结核性胸膜炎的诊断价值

Diagnostic values of different detection methods for tuberculous pleurisy

目的探讨结核分枝杆菌/利福平耐药基因(Xpert MTB/RIF)检测、结核感染T细胞斑点试验(T-SPOT.B)和腺苷脱氨酶(ADA)检测胸腔积液在结核性胸膜炎诊断中的价值。方法选择2019年1月至2021年4月就诊于北京老年医院感染科的167例胸腔积液患者为研究对象,其中确诊为结核性胸膜炎患者114例(结核性胸膜炎组),非结核性胸膜炎53例(非结核性胸膜炎组)。2组患者均抽取胸腔积液进行Xpert MTB/RIF、T-SPOT.TB和ADA检测,并对检测结果进行比较。采用SPSS 23.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验进行组间比较。结果诊断灵敏度比较,ADA(73.68%)>Xpert MTB/RIF(37.72%)>罗氏培养(23.68%),差异均有统计学意义(χ^(2)=29.880,5.277;P<0.05);T-SPOT.TB(81.58%)和ADA(73.68%)比较,差异无统计学意义(χ^(2)=2.046;P>0.05)。特异度比较,Xpert MTB/RIF(100.00%)与罗氏培养(100.00%)均高于T-SPOT.TB(81.13%),也高于ADA(71.70%),差异均有统计学意义(χ^(2)=11.042,11.042,17.473,17.473;P<0.05);而T-SPOT.TB(81.13%)和ADA(71.70%)比较,差异无统计学意义(χ^(2)=1.309;P>0.05)。3种方法串联时,T-SPOT.TB和ADA检测灵敏度(60.53%)明显高于Xpert MTB/RIF和ADA(35.96%),差异有统计学意义(χ^(2)=20.081,P<0.001)。并联时,T-SPOT.TB或ADA检测灵敏度(94.74%)明显高于单独ADA(73.68%)或单独T-SPOT.TB检测(81.58%),差异有统计学意义(χ^(2)=19.000,9.453;P<0.05)。而血T-SPOT.TB或ADA或Xpert MTB/RIF检测(96.49%)与T-SPOT.TB或ADA检测(94.74%)灵敏度比较,差异无统计学意义(χ^(2)=0.418,P>0.05)。两者或三者串联检测,特异度无显著差异(P>0.05)。并联检测,SPOT.TB或ADA(62.26%)特异度与T-SPOT.TB或ADA或Xpert MTB/RIF特异度(62.26%)相同,均低于Xpert MTB/RIF或T-SPOT.TB(81.13%),差异有统计学意义(χ^(2)=4.649,4.649;P<0.05);其余组间特异度两两比较,差异均无统计学意义(P>0.05)。结论T-SPOT.TB和ADA检测胸腔积液在诊断结核性胸膜炎中具有较高的灵敏度和特异度,而Xpert MTB/RIF在胸腔积液标本中的诊断价值较低。T-SPOT.TB和ADA联合检测可提高诊断结核性胸膜炎的灵敏度,更好地降低漏诊率。

Objective To investigate the values of mycobacterium tuberculosis/rifampicin resistance gene(Xpert MTB/RIF)detection,T cell spot test(T-SPOT.TB)and adenosine deaminase(ADA)assay in detection of pleural fluid in the diagnosis of pleural tuberculosis.Methods A total of 167 patients with pleural fluid admitted to Department of Infective Diseases of Beijing Geriatric Hospital from January 2009 to April 2021 were recruited in this study,and 114 of them were diagnosed with tuberculous pleurisy(TBP group)and 53 cases were not(non-TBP group).Every patient was tested with Xpert MTB/RIF detection,T-SPOT.TB and ADA assays in pleural effusion.SPSS statistics 23.0 was used to perform the statistical analysis.Student′s t test,rank-sum test or Chi-square test was employed for intergroup comparison based on different data types.Results The highest sensitivity was observed in ADA assay(73.68%),followed by Xpert MTB/RIF assay(37.72%)and then Roche culture(23.68%),with statistical differences among them(χ^(2)=29.880,5.277;P<0.05).There was no significant difference in the sensitivity between T-SPOT.TB(81.58%)and ADA assays(73.68%,χ^(2)=2.046;P>0.05).The specificity was significantly higher in Xpert MTB/RIF assay(100.00%)and Roche culture(100.00%)than T-SPOT.TB assay(81.13%,χ^(2)=11.042,11.042;P<0.05),and also higher than that of ADA assay(71.70%,χ^(2)=17.473,17.473;P<0.05).But there was no significant difference in the specificity between T-SPOT.TB(81.13%)and ADA assays(71.70%,χ^(2)=1.309;P>0.05).When the three methods were connected in series,the detection sensitivity of T-SPOT.TB and ADA assays was obviously higher than that of Xpert MTB/RIF and ADA assays(60.53%vs 35.96%,χ^(2)=20.081,P<0.001).In parallel connection,the sensitivity of T-SPOT.TB or ADA assays(94.74%)was notably higher than that of ADA assay alone(73.68%)or T-SPOT.TB assay alone(81.58%,χ^(2)=19.000,9.453;P<0.05).No statistical differences were seen in the sensitivity of T-SPOT.TB or ADA or Xpert MTB/RIF(96.49%)with sensitivity of T-SPOT.TB or ADA(94.74%,χ^(2)=0.418,P>0.05).There was no significant difference in specificity between the two or three tests in series(P>0.05).In parallel connection,T-SPOT.TB or ADA(62.26%)and T-SPOT TB or ADA or Xpert MTB/RIF had the same specificity(62.26%),which were lower than that of Xpert MTB/RIF or T-SPOT TB(81.13%),and the difference was statistically significant(χ^(2)=4.649,4.649;P<0.05);and there was no significant difference in other groups in pairwise comparison of specificity(P>0.05).Conclusion T-SPOT.TB and ADA assays for pleural fluid patients obtain higher sensitivity and specificity in the diagnosis of tuberculous pleurisy,while Xpert MTB/RIF has lower diagnostic value.Combined detection of pleural fluid with T-SPOT.TB and ADA assay can improve the sensitivity and better reduce the missed diagnosis rate of tuberculous pleurisy.