血、胸水结核感染效应T细胞检测联合胸水腺苷脱氨酶诊断结核性胸膜炎的价值

The value of peripheral blood and pleural effusion T-SPOT.TB combined with pleural effusion adenosine deaminase in diagnosis of tuberculous pleurisy

目的 探讨外周血、胸水结核感染效应T细胞检测(T-cell spot test for tuberculosis infection, T-SPOT.TB)及两者间的量效关系,同时进一步评估联合胸水腺苷脱氨酶(adenosine deaminase, ADA)对结核性胸膜炎的诊断价值。方法 对2017年1月至2020年12月在南通市第六人民医院就诊的80例结核性胸膜炎及70例非结核性胸膜炎相关检测数据进行分析。利用T-SPOT技术同时检测患者外周血及胸水中结核感染效应T细胞,采用速率法检测胸水中ADA。应用受试者工作特征曲线(receiver operator characteristic curve, ROC)取胸水ADA最佳临界值,比较不同临界值时的灵敏度与特异度。应用Person相性分析外周血与胸水T-SPOT.TB相关性。将外周血、胸水T-SPOT.TB及胸水ADA三者检测进行数据整合。结果 当胸水ADA>45 U/L时,诊断结核性胸膜炎的灵敏度和特异度分别为50.0%、94.3%;而取>25.15 U/L时,其灵敏度和特异度分别为80.0%和72.9%。胸水ADA>45 U/L,胸水/血T-SPOT.TB斑点数比值(spot forming cells, SFCs)>2倍,诊断结核性胸膜炎的特异度最高,为100%。25.15 U/L<胸水ADA≤45 U/L,胸水/血TSPOT.TB斑点数比值>2倍,特异度92.3%(次之)。胸水ADA≤25.15 U/L,胸水/血T-SPOT.TB斑点数比值>2倍,特异度83.3%(3组中最低)。结论 胸水ADA水平的变化可用作诊断结核性胸膜炎常用方法之一。再进一步联合胸水及血T-SPOT.TB,若胸水/血T-SPOT.TB斑点数比值大于2倍,能进一步提高结核性胸膜炎的诊断率。

Objective To explore the relationship between peripheral blood and pleural effusion tuberculosis (TB)infection effector T cells,and to further evaluate the value of combined pleural effusion adenosine deaminase (ADA) for rapid diagnosis of tuberculous pleurisy.Methods The test data of 80 cases of tuberculous pleurisy and 70 cases of nontuberculous pleurisy treated in the Sixth People’s Hospital of Nantong City from January 2017 to December 2020 were analyzed.The TB-infected effector T cells were also detected simultaneously in the peripheral blood and the pleural effusion by the T-SPOT technique,and the pleural effusion ADA was detected by the rate method.The subject operating characteristic curve (ROC) was applied to take the optimal pleural effusion ADA threshold to compare the sensitivity and specificity of different critical values.Person phase analysis was applied to analyze the correlation between peripheral blood and pleural effusion T-SPOT.TB.Data of peripheral blood,pleural effusion T-SPOT.TB and ADA were integrated.Results When pleural effusion ADA>45 U/L,the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 50.0%and 94.3%,respectively;when ADA>25.15 U/L,the sensitivity and specificity were 80.0%and 72.9%.When ADA>45 U/L,pleural/blood T-SPOT.TB spot ratio (spot forming cells,SFCs)>2 times,the specificity for the diagnosis of tuberculous pleurisy was 100%(highest);when 25.15 U/L2 times,the specificity for the diagnosis of tuberculous pleurisy was 92.3%(second).When pleural effusion ADA≤25.15 U/L,and the pleural effusion/blood T-SPOT.TB spot number ratio>2 times,with 83.3%specificity (the lowest of the three groups).Conclusions The level of pleural effusion ADA is one of the most used methods for diagnosing tuberculous pleurisy.Further combination of pleural effusion and blood T-SPOT.TB,if the ratio of pleural effusion/blood T-SPOT.TB spots is greater than 2 times,it can further improve the diagnosis rate of tuberculous pleurisy.