T-Spot试验在结核病诊断中的价值

目的 评价T-Spot检测在结核病诊断中的作用。方法 回顾性分析2016年1月1日至2016年9月30日在同济大学附属肺科医院同批次进行T-Spot、痰液结核菌培养、痰结核菌荧光染色涂片、痰TB-SAT和结合抗体检测的患者479例,计算T-Spot试验在结核病诊断中的灵敏度、特异度、阴阳性预测值,评价T-Spot检测在在结核病诊断中的作用。 结果 T-Spot检测的灵敏度为96.47%(355/368),特异度为78.38%(87/111),阳性预测值93.67%(355/379),阴性预测值为87%(87/100)。T-Spot在肺结核和肺外结核中的敏感性分别为96.77%(270/279)和95.5%(85/89),特异性为78.38%(87/111),两者差异无统计学意义(P＞0.05)。T-Spot试验灵敏度高于痰液结核菌培养、痰结核菌荧光染色涂片、痰TB-SAT和结合抗体检测,差异有统计学意义(P＜0.05)。外周血T-Spot检测联合TB-Ab检测敏感性为98.10%(361/368),对比T-Spot单项检测差异有统计学意义(P＜0.05)。菌阴性结核患者T-Spot检测敏感性为95.48%(148/155),特异性为92.47%(86/93),肺结核与肺外结核患者差异无统计学意义。 结论 T-Spot检测可辅助临床诊断或排除结核,T-Spot检测联合血清结合抗体检测可提高结核患者检出率,T-Spot检测有助于菌阴性结核患者的诊断。
Objective To evaluate the application of T-Spot test for diagnosis of tuberculosis. Methods The clinical and laboratory data of 479 patients, including 279 with pulmonary tuberculosis, 89 with extrapulmonary tuberculosis and 111 non-tuberculosis patients (control group), admitted in Pulmonary Hospital, Tongji University from January 2016 to September 2016 were retrospectively reviewed. T-spot test, fluorescent staining, bacterial culture of sputum, TB-Sat and the TB-Ab test were performed in all patients. The sensitivity, specificity, positive predictive value and negative predictive value of tests were analyzed. Results The sensitivity, specificity, negative predictive value and positive predictive value of T-Spot test for diagnosis of tuberculosis were 96.47%(355/368), 78.38%(87/111), 93.67%(355/379)and 87%(87/100), respectively. The sensitivity of T-Spot in diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis were 96.77%(270/279)and 95.5%(85/89)respectively(P＞0.05) and the specificity was 78.38%(87/111). The sensitivity of T-Spot in diagnosis of tuberculosis was higher than that of fluorescent staining, bacterial culture of sputum, TB-Sat and TB-Ab test(P＜0.05). Compared to single tests, the sensitivity of combined detection of T-Spot and TB-Ab test was increased to 98.10% (361/368, P＜0.05). The sensitivity of T-Spot in the patients with bacterial negative tuberculosis was 95.48% (148/155), and the specificity was 92.47% (86/93); and there was no significant difference between the patients with pulmonary tuberculosis and extrapulmonary tuberculosis. Conclusion T-Spot test is effective in detection of tuberculosis, particularly for bacteria negative patients; and combined T-Spot with TB-Ab test can improve the detection rate