T细胞斑点检测、涂片检查及结核菌素试验在儿童结核病诊断中的应用

Application of T-cell spot test,smear test and purified protein derivative of tuberculin test in the diagnosis of tuberculosis in children

目的:探讨T细胞斑点检测(T-SPOT.TB)、涂片检查及结核菌素试验(PPD)在儿童结核病诊断中的应用效果。方法:选取2019年1月~2020年5月我院收治的156例疑似肺结核患儿为研究对象,所有患儿均行T-SPOT.TB、涂片检查及PPD,以痰结核菌检查为金标准,比较三种检查方法及联合检查的诊断灵敏度、特异度、准确率、阳性预测值、阴性预测值及kappa值。结果:T-SPOT.TB试验诊断肺结核kappa值最高为0.839,涂片检查诊断肺结核kappa值最低为0.523,PPD试验诊断肺结核kappa值为0.641。肺结核及肺外结核中,三种检测方法灵敏度差异均具有统计学意义,其中T-SPOT.TB试验灵敏度最高,涂片检查最低(P<0.05)。结论:T-SPOT.TB诊断儿童肺结核中与金标准的一致性较涂片检查及PPD高,在肺外结核中也具有较高灵敏度,临床应用效果较好。

Objective:To investigate the application of T-cell spot test(T-SPOT.TB),smear test and purified protein derivative of tuberculin test(PPD)in the diagnosis of tuberculosis in children.Methods:156 children with suspected tuberculosis admitted to our hospital from January 2019 to May 2020 were selected as the research subjects.All children underwent T-SPOT.TB,smear test and PPD.Taking sputum tuberculosis examination as the gold standard,the diagnostic sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value and kappa value were compared among the three test methods and the combined test.Results:The Kappa value was 0.839 in T-SPOT.TB test,0.523 in smear test,and 0.641 in PPD test in the diagnosis of tuberculosis.There was a statistically significant difference in the sensitivity of the three test methods in the diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis.And TSPOT.TB test had the highest sensitivity and smear test had the lowest(P<0.05).Conclusion:T-SPOT.TB is highly consistent with the gold standard in the diagnosis of tuberculosis in children than smear test and PPD.It also has higher sensitivity in extrapulmonary tuberculosis.