结核免疫斑点试验与结核菌素试验在活动性结核病诊断中的优越性对比

摘要

Objective To compare the value of enzyme-linked immunospot assay for inferferon-γand tuberculin puri-fied protein derivative ( PPD) skin test in the diagnosis of active tuberculosis ( TB) . Method 124 cases of patients with suspected active tuberculosis from April 2013 to May 2014 in Zhejiang Jinhua Guangfu hospital were prospec-tive studied, and followed up for at least 6 months. 43 cases of patients were confirmed for TB, 72 cases were ex-cluded from TB, and 9 cases are eliminated from this study. All patients were performed T-SPOT. TB and PPD test. The main diagnostic experiment indexes of the two testing methods were compared. Result The sensitivity and speci-ficity of the T-SPOT. TB were 90. 70% and 83. 33% respectively;the sensitivity and specificity of the PPD were 32. 56% and 79. 17% respectively. The percent agreement of T-SPOT. TB and PPD were 86. 09%, 61. 74%, PPV were 76. 47%, 48. 28%, NPV were 93. 75%,66. 28% respectively. The PLR and NLR of T-SPOT. TB were 5. 32 and 0. 096 respectively,PPD were 1. 56 and 0. 852. Conclution The value in active TB diagnosis of T-SPOT. TB were significantly superior to PPD, while it cannot completely replace PPD. It is necessary to conduct both T-SPOT. TB and PPD detection of tuberculosis infection.%目的：比较结核免疫斑点试验( enzyme-linked immunospot assay for inferferon-γ,T-SPOT. TB)与结核菌素试验( purified protein derivative,PPD)在活动性结核病诊断中的优越性。方法前瞻性研究2013年4月至2014年5月本院收治的疑似活动性结核病患者124例,随访至少6个月,证实结核患者43例,排除结核病72例,剔除9例。所有患者均行T-SPOT. TB与PPD检测,比较两组检验方法的主要诊断实验指标。结果 T-SPOT. TB和PPD的敏感度分别为90.70%、32.56%；特异度分别为83.33%、79.17%。检测的符合率分别为86.09%、61.74%,阳性预测值分别为76.47%、48.28%,阴性预测值分别为93.75%、66.28%；阳性似然比分别为5.32、1.56,阴性似然比分别为0.096、0.852。结论 T-SPOT. TB在活动性结核病中的诊断价值明显优于PPD,但不能完全取代PPD,临床上有必要进行联合开展。