结核感染T细胞斑点试验联合腺苷脱氨酶检测诊断结核性胸膜炎的价值

摘要

目的 分析结核感染T细胞斑点试验(T-SPOT.TB)联合腺苷脱氨酶(ADA)检测诊断结核性胸膜炎的价值.方法 对2015年1-12月黑龙江省传染病防治院确诊或临床诊断为结核性胸膜炎的145例患者和非结核性胸膜炎的59例患者进行回顾性分析.204例患者均于治疗前进行了胸腔积液T-SPOT.TB和ADA检测及外周血T-SPOT.TB检测;对患者胸腔积液T-SPOT.TB、胸腔积液ADA、外周血T-SPOT.TB单独检测,以及胸腔积液T-SPOT.TB与胸腔积液ADA联合检测的结果进行比较.结果 胸腔积液T-SPOT.TB诊断结核性胸膜炎的敏感度(98.62％,143/145)高于外周血T-SPOT.TB(88.97％,129/145)和胸腔积液ADA(87.59％,127/145),差异均有统计学意义(x2=11.61,P＜0.001;x2=13.75,P＜0.001);胸腔积液ADA检测的特异度(91.53％,54/59)均高于胸腔积液T-SPOT.TB(64.41％,38/59)和外周血T-SPOT.TB(61.02％,36/59),差异均有统计学意义(x2=12.63,P＜0.001;x2=15.17,P＜0.001);将胸腔积液T-SPOT.TB与ADA联合检测和胸腔积液T SPOT.TB单独检测进行比较,诊断结核性胸膜炎的敏感度由98.62％(143/145)降低至86.21％(125/145),差异有统计学意义(x2=15.94,P＜0.001),但特异度由64.41％(38/59)升高至100.00％(59/59),差异有统计学意义(x2=25.55,P＜0.001).结论 胸腔积液T-SPOT.TB检测结核性胸膜炎具有较高的敏感度和特异度,胸腔积液T-SPOT.TB和ADA联合检测可明显提高诊断的特异度.%Objective To evaluate the diagnostic value of the Mycobacterium tuberculosis T cell enzyme-linked immunospot test for tuberculosis (T-SPOT.TB) and adenosine deaminase (ADA) testing in patients with pleural tuberculosis.Methods One hundred and forty-five patients with confirmed or clinically diagnosed pleural tuberculosis and 59 patients with non-pleural tuberculosis were enrolled in this study from January 2015 to December 2015;all diagnoses were retrospectively analyzed.Pleural effusions and peripheral blood samples were collected from all 204 patients in the study before the onset of treatment and subsequently tested using T-SPOT.TB.ADA levels in pleural effusions were also measured.Pleural effusion T-SPOT.TB results,pleural effusion ADA levels and peripheral blood T-SPOT.TB results were compared separately,and against a combination of pleural effusion T-SPOT.TB and ADA levels.Results The sensitivity of pleural effusion T-SPOT.TB (98.62％,143/145) was significantly higher than that for peripheral blood T-SPOT.TB (88.97％,129/145) and pleural effusion ADA (87.59％,127/145) (x2 =11.61,P＜0.001;x2 =13.75,P＜ 0.001).The specificity of pleural effusion ADA (91.53 ％,54/59) was significantly higher than that of pleural effusion T-SPOT.TB (64.41％,38/59) and peripheral blood T-SPOT.TB (61.02％,36/59),(x2 =12.63,P＜0.001;x2 =15.17,P＜0.001).Combining detection of pleural effusion T-SPOT.TB and ADA levels reduced the sensitivity from 98.62％ (143/145) to 86.21％ (125/145),compared with pleural effusion T-SPOT.TB (x2 =15.94,P＜0.001),but increased specificity from 64.41 ％ (38/59) to 100.00％ (59/59) (x2 =25.55,P＜0.001).Conclusion Pleural effusion T-SPOT.TB is a highly sensitive and specific method for the detection of pleural tuberculosis.Combining pleural effusion T-SPOT.TB results with ADA testing can significantly improve diagnostic specificity.