【摘要】 目的:评价结核感染T细胞斑点试验(T-SPOT.TB)对肺结核病的临床诊断价值。方法:选择2012年2月~8月湘雅医院呼吸科住院病人中92例可疑肺结核患者进行T-SPOT.TB检测、结核菌素试验(PPD试验)、结核抗体、血沉及影像学检查及病史收集。分析和比较T-SPOT.TB与传统结核诊断方法的阳性率、特异度、灵敏度并对其检测结果进行相关性分析。结果:92例患者中,48例被确诊为肺结核,其中41例T-SPOT.TB结果阳性,44例非肺结核患者中5例T-SPOT.TB结果阳性。T-SPOT.TB检测的敏感度为85.4%,特异度为88.6%。T-SPOT.TB检测在结核组的阳性检出率(85.4%)显著高于传统检查方法 PPD(37.5%,P<0.01)、结核抗体(16.7%,P<0.01)、血沉(66.7%,P<0.05),在非结核病组中的特异性(88.6%)显著高于血沉(36.6%,P<0.01)。PPD与T-SPOT.TB联合可提高诊断结核的阳性率(89.6%)。T-SPOT.TB检测仅与PPD试验的结果存在显著性差异(P<0.05)。结论:T-SPOT.TB诊断肺结核的敏感性及特异性较传统的PPD实验、结核抗体更高,具有重要的临床应用价值。更多还原

【Abstract】 Objective: To evaluate the diagnostic value of T-SPOT.TB assay in pulmonary tuberculosis. Methods: A retrospective study enrolling 92 inpatients of respiratory department with suspected pulmonary tuberculosis was conducted. T-SPOT.TB, PPD skin test, tuberculosis antibody, erythrocyte sedimentation rate and radiographic examination were checked. The diagnostic positive rate, specificity of T-SPOT.TB in pulmonary tuberculosis were evaluated and compared with those traditional TB diagnosis methods. Results: In 92 suspected pulmonary tuberculosis patients, 48 patients were definitely diognosed as TB, in which 41 cases were T-SPOT.TB positive. In 44 patients of the non-TB group, 5 cases were T-SPOT.TB positive. The sensitivity of T-SPOT.TB assay was 85.4% and specificity was 88.6%. As for the sensitivity in discoving TB patient, T-SPOT.TB(85.4%) was significantly superior to those traditional TB diagnosis methods including PPD skin test(37.5%, P<0.01), tuberculosis antibody(16.7%, P<0.01), erythrocyte sedimentation rate(ESR)(66.7%, P <0.05). The specificity of T-SPOT.TB in non-TB group(88.6%) was significantly superior to the erythrocyte sedimentation rate(36.6%, P <0.01). Combination of PPD skin test and T-SPOT.TB may improve the diagnosis of TB(positive rate was 89.6%). Consistency analysis was conducted between T-SPOT.TB and traditional TB diagnosis methods, the result showed that T-SPOT.TB was only significantly different from the PPD skin test(x2=4.646, P=0.031). Conclusion: The T-SPOT.TB had higher sensitivity and specificity in comparison to traditional TB diagnosis methods, which turned out to have surperior clinical diagnosis value.更多还原