目的：分析胸腔镜胸膜活检联合外周血T-SPOT-TB试验对结核性胸膜炎的诊断价值。方法2012年2月-2015年4月解放军第210医院呼吸内科就诊的疑似结核性胸膜炎患者98例，根据《肺结核诊断和治疗指南》确诊为结核性胸膜炎患者60例，非结核性胸膜炎患者38例。98例患者先后行胸腔镜胸膜活检和外周血T-SPOT-TB试验，比较单独行T-SPOT-TB试验检查和联合检查的准确性。结果①60例已确诊为结核性胸膜炎的患者经单独T-SPOT-TB试验检查和联合检查，联合检查的敏感度为93．33%，高于单独T-SPOT-TB试验检查80．00%和单独胸腔镜胸膜活检60．00%，两者差异均有显著性( P<0．05)。②38例确诊为非结核性胸膜炎的患者分别经单独T-SPOT-TB试验检查和联合检查，联合检查的特异度为97．37%，明显高于单独T-SPOT-TB试验检查81．58%和单独胸腔镜胸膜活检65．79%，两者差异均有显著性( P<0．05)。③联合检查的阳性预测值为98．24%，明显高于单独T-SPOT-TB试验检查87．27%和单独胸腔镜胸膜活检73．47%，两者差异有显著性(P<0．05)。④联合检查的阴性预测值为90．24%，明显高于单独T-SPOT-TB试验检查72．09%和单独胸腔镜胸膜活检51．02%，两者差异有显著性( P<0．05)。⑤联合检查的诊断率为94．90%，明显高于单独T-SPOT-TB试验检查80．61%和单独胸腔镜胸膜活检62．24%，两者差异有显著性( P<0．05)。结论胸腔镜胸膜活检联合外周血结核感染T细胞体外释放酶链免疫试验的敏感度、特异度、阳性预测值、阴性预测值和诊断率均高于单独应用外周血结核感染T细胞体外释放酶链免疫试验，联合检验对结核性胸膜炎有较高的诊断价值。%Objective To analyze the diagnostic value of thoracoscopic pleural biopsy joint peripheral blood T-SPOT-TB on tuberculous pleurisy. Methods 98 cases suspected with tuberculous pleurisy from February 2012 to April 2015 were enrolled, and 60 cases were confirmed with tuberculous pleurisy and 38 cases with non-tuberculous pleurisy by Pulmonary Tuberculosis Diagnosis and Treatment Guidance. 98 patients underwent thoracoscopic pleural biopsy and peripheral blood T-SPOT-TB test to compare the accuracy of a separate line T-SPOT-TB test and joint inspections. Results ① 60 patients with tuberculous pleurisy received a single T-SPOT-TB test and joint inspec-tion. The sensitivity of joint inspection was 93. 33%, higher than the single T-SPOT-TB test (80. 00%) and thoraco-scopic pleural biopsy ( 60. 00%) ( P <0. 05 ) . ②38 patients with non-tuberculous pleurisy received a single T-SPOT-TB test and joint inspection. The specificity of joint inspection was 97. 37%, significantly higher than single T-SPOT-TB test (81. 58%) and thoracoscopic pleural biopsy (65. 79%) (P<0. 05). ③The positive predictive value of joint inspection was 98. 24%, significantly higher than single T-SPOT-TB test (87. 27%) and thoracoscopic pleu-ral biopsy (73. 47%) (P<0. 05). ④ The negative predictive value of joint inspection was 90. 24%, significantly higher than single T-SPOT-TB (72. 09%) and thoracoscopic pleural biopsy (51. 02%) (P<0. 05). ⑤The diagno-sis rate of joint inspection was 94. 90%, significantly higher than single T-SPOT-TB ( 80. 61%) and thoracoscopic pleural biopsy (62. 24%) (P<0. 05). Conclusion The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic rate of thoracoscopic pleural biopsy joint peripheral blood T-SPOT-TB are all higher than peripheral blood T-SPOT-TB, which means the joint inspection of tuberculous pleurisy has high diagnostic value.
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