三种胸腔积液检测方法对结核性胸膜炎诊断价值的研究

摘要

目的 比较胸腔积液腺苷脱氨酶(adenosine deamianse,ADA)、结核感染T细胞斑点试验(T-SPOT.TB)和结核分枝杆菌/利福平耐药基因检测(Xpert MTB/RIF)在结核性胸膜炎诊断中的价值.方法 回顾性分析140例胸膜炎患者的临床资料,其中结核性胸膜炎患者90例,非结核性胸膜炎患者50例,两组患者均抽取胸腔积液送检ADA、T-SPOT.TB和Xpert MTB/RIF检测,比较两组患者的检测结果.结果 结核性胸膜炎患者胸腔积液ADA为(45.3±22.6)U/L,明显高于非结核性胸膜炎患者(23.2±23)U/L,差异有显著性(t=3.893,P=0.000),ADA诊断结核性胸膜炎的敏感度、特异度分别为71.1%和84%.结核性胸膜炎和非结核性胸膜炎患者胸腔积液T-SPOT.TB的中位数分别为1000 SFCs(931,1000)和32 SFCs(4,200),两组比较差异有显著性(U=126.0,P=0.000),其诊断结核性胸膜炎的敏感度、特异度分别为84.4%和96%.胸腔积液Xpert MTB/RIF诊断结核性胸膜炎的敏感度、特异度分别为13.3%和100%.胸腔积液ADA、胸腔积液T-SPOT.TB的敏感度均明显高于胸腔积液Xpert MTB/RIF(χ2=30.789,P=0.000;χ2=45.534,P=0.000).胸腔积液ADA和胸腔积液T-SPOT.TB的敏感度差异无显著性(χ2=2.314, P=0.204).三种检测方法的特异度差异均无显著性.结论 胸腔积液T-SPOT.TB和ADA诊断结核性胸膜炎具有较高的敏感度和特异度,而Xpert MTB/RIF对胸腔积液标本的诊断价值则较低.胸腔积液T-SPOT.TB和ADA二者联合检测可以提高结核性胸膜炎诊断的敏感度.%Objective This research investigated to evaluate the performance of ADA, T-SPOT.TB and Xpert Mtb /RIF assay in pleural fluid (PF) for diagnosis of pleural tuberculosis (PTB). Method A total of 140 patients were enrolled in this research. 90 cases were diagnosed as PTB, 50 cases were Non-PTB patients. ADA, T-SPOT.TB and Xpert Mtb/RIF in PF were tested in both groups. Result PF ADA in PTB patients was (45.3±22.6) U/L, which was significantly higher than that in non-PTB group [(23.2±23) U/L, (t=3.893, P=0.000)]. The sensitivity and specificity of diagnosis of PTB were 71.1% and 84%, respectively. The median PF T-SPOT.TB was 1000 SFCs (931, 1000) and 32 SFCs (4,200) in patients with PTB and non-PTB, respectively. There was a significant difference between the two groups (U=126.0, P=0.000).The sensitivity and specificity for the diagnosis of PTB were 84.4% and 96%.The sensitivity and specificity of PF Xpert Mtb/RIF for diagnosis of PTB were 13.3% and 100%. The sensitivity of PF ADA and T-SPOT.TB were significantly higher than that of PF Xpert Mtb/RIF (χ2=30.789, P=0.000; χ2=45.534, P=0.000). There was no significant difference in the sensitivity of PF ADA and T-SPOT. TB (χ2=2.314, P=0.204). There was no significant difference in the specificity of the three detection methods. Conclusion PF T-SPOT.TB and ADA test had a high sensitivity and specificity for the diagnosis of PTB, while Xpert Mtb/RIF test has a lower diagnostic value for PF specimens. The combined detection of PF T-SPOT.TB and ADA can improve the diagnostic sensitivity of PTB.