T-SPOT.TB在具有高危因素的疑似肺结核病例中的辅助诊断价值及影响因素分析

Diagnostic value of T-SPOT.TB in suspected pulmonary tuberculosis patients with high risk factors and its influencing factors

目的探讨结核感染T细胞斑点试验(T-cell spot of tuberculosis test,T-SPOT.TB)在具有高危因素的疑似肺结核病例中的辅助诊断价值及影响因素。方法回顾性分析2017年10月至2020年10月我院住院的疑似肺结核病例454例,据是否合并高危因素,分为高危组和非高危组,分析T-SPOT.TB在不同组中的诊断价值,并应用Logistic回归方法分析T-SPOT.TB产生假阴性和假阳性结果的影响因素。结果T-SPOT.TB在高危组及非高危组中的灵敏度分别为76.34%、90.00%,特异度分别为76.35%、82.93%,准确度分别为76.35%、85.92%,组间比较显示灵敏度及准确度差异有统计学意义(P=0.014;P=0.010),而两组之间特异度差异无统计学意义(P=0.183)。Logistic回归分析显示年龄≥65岁(P=0.019)为假阴性的危险因素,性别(男性)(P=0.001)、恶性肿瘤(P<0.001)为假阳性的危险因素。结论T-SPOT.TB在辅助诊断肺结核时具有较高价值,尤其在非高危组辅助诊断价值更高;在临床应用T-SPOT.TB辅助诊断肺结核时要考虑到T-SPOT.TB假阴性和假阳性的危险因素。

Objective To investigate the diagnostic value of T-cell spot of tuberculosis test(T-SPOT.TB)in suspected pulmonary tuberculosis patients with high risk factors and its influencing factors.Methods The clinical data of 454 adult hospitalized patients with suspected tuberculosis in our hospital from October 2017 to October 2020 were retrospectively analyzed.According to the combination of high risk factors,they were divided into the high risk group and the non-high risk group.The diagnostic value of T-SPOT.TB in different groups was analyzed,and the influencing factors of false negative and false positive were investigated by Logistic regression method.Results The sensitivity of T-SPOT.TB in the high-risk group and the non-high-risk group was 76.34%and 90.00%,the specificity was 76.35%and 82.93%,and the accuracy was 76.35%and 85.92%,respectively.There were significant differences in sensitivity and accuracy between the two groups(P=0.014;P=0.010),but there was no statistically significant difference in specificity between the two groups(P=0.183).Logistic regression analysis showed that age≥65 years old(P=0.019)was the risk factor for T-SPOT.TB′s false negative results,while gender(male)(P=0.001)and malignant tumor(P<0.001)were risk factors for T-SPOT.TB′s false positive results.Conclusion T-SPOT.TB has a high value in auxiliary diagnosis of tuberculosis,especially in the non-high-risk group,the auxiliary diagnostic value is higher.The false negative and false positive risk factors of T-SPOT.TB should be considered in clinical application of T-SPOT.TB as an adjunctive test for the diagnosis of tuberculosis patients.