【摘要】 目的评价外周血及胸腔积液γ-干扰素释放试验对结核性胸腔积液诊断的价值。方法应用外周血及胸腔积液γ-干扰素释放试验T-SPOT.TB对56例胸腔积液患者进行检测,其中结核性胸膜炎患者38例,非结核性胸膜炎患者18例。评价外周血及胸腔积液T-SPOT.TB的敏感度、特异度、阳性预测值、阴性预测值等。结果外周血与胸腔积液的T-SPOT.TB敏感度、特异度、阳性预测值、阴性预测值分别为86.5%(95%CI 71.2%~95.5%)和100%(95%CI90.5%~100%);52.9%(95%CI 27.8%~77.0%)和35.3%(95%CI 14.2%~61.7%);80.0%(95%CI 64.4%~90.9%)和77.1%(95%CI62.7%~88.0%);64.3%(95%CI 35.1%~87.2%)和100%(95%CI 54.1%~100%)。通过ROC曲线得出,当胸腔积液T-SPOT.TB的结果取47SFC/2.5×105个细胞为临界值时,诊断结核性胸膜炎的敏感度可达到89.2%,特异度88.2%。结论与外周血γ-干扰素释放试验T-SPOT.TB比较,胸腔积液T-SPOT.TB可能对结核性胸膜炎有更高的诊断价值,且47SFC/2.5×105个细胞可能是区分结核和非结核性胸膜炎的一个参考临界值。更多还原

【Abstract】 Objective To evaluate the diagnostic value of interferon-γ release assay of blood and pleural effusion for tuberculous pleurisy. Methods Fifty-six adult patients with suspected tuberculous pleurisy were enrolled in our study. The blood and pleural effusion interferon-γ release assay were measured by T-SPOT.TB test in 38 pleural tuberculosis patients and 18 nontuberculous pleurisy controls. The diagnostic sensitivity, specificity, predictive value of T-SPOT.TB in pleural effusion mononuclear cells(PE-MC) and peripheral mononuclear cells(PBMC) were analyzed. Results The sensitivities and specificities, positive predictive values and negative predictive values, respectively, of the PE-MC and PBMC for diagnosing were as follows: 86.5%(95% confidence interval[CI] 71.2%-95.5%) and 100%(95%CI 90.5%-100%); 52.9%(95%CI 27.8%-77.0%) and 35.3%(95%CI 14.2%-61.7%); 80.0%(95%CI 64.4%-90.9%) and 77.1%(95%CI 62.7%-88.0%); 64.3%(95%CI 35.1%-87.2%) and 100%(95%CI 54.1%-100%). By ROC curve analysis, a cut-off value of 47 SFC/2.5×105 cells in PE-MC showed a sensitivity of 89.2% and a specificity of 88.2%. Conclusion T-SPOT.TB in PE-MC could be an accurate diagnostic method for tuberculous pleurisy in TB endemic settings. Moreover, 47 SFC/2.5×10~5 cells might be the optimal cut-off value for diagnosing tuberculous pleurisy.更多还原