结核感染T细胞斑点试验、PPD、CRP在儿童结核诊治的临床意义

目的：分析儿童结核病诊断中结核感染T细胞斑点试验（T-SPOT-TB）的应用价值。方法随机选取2014年1月—2015年7月在福建省福州肺科医院住院的儿童结核及非结核性肺部疾病患儿90例,包括结核病47例（A组）和非结核性肺部疾病患儿43例（B组）,采用SPSS 18.0统计学软件进行分析,采用χ2检验比较T-SPOT-TB与痰抗酸杆菌涂片、结核分枝杆菌培养、结核抗体、PPD试验,比较其检测结果,以P<0.05为差异有统计学意义,同时对两组患儿进行C反应蛋白（CRP）测定,分析CRP在结核病鉴别诊断中的意义。结果 T-SPOT-TB检测诊断结核病的敏感度为87.2%（41/47）,特异度为97.7%（42/43）,PPD试验诊断结核病的敏感度为48.9%（23/47）,特异度为67.4%（29/43）,与PPD试验相比,T-SPOT-TB检测诊断结核病的敏感度及特异度均比 PPD试验高,差异均有统计学意义（χ2=11.15,11.07,P<0.05）。结核病患儿T-SPOT-TB检测的阳性率为87.2%,显著高于结核抗体检测、抗酸杆菌涂片、结核分枝杆菌培养,差异均有统计学意义（χ2=25.03、31.03、16.41,P<0.05）。 CRP测定结核病组的平均值为（33.09±19.96）,非结核病组的平均值为（26.79±18.13）,两组统计学比较差异无统计学意义（P>0.05）。结论 T-SPOT-TB检测具有较高的敏感度和特异度,是诊断儿童结核的快速敏感方法,在儿童结核早期临床诊断中有重要的应用价值。结核病中C反应蛋白可升高,但是单纯的C反应蛋白测定在鉴别结核病与非结核性疾病中意义不大。

The Clinical Significance of Spot test,PPD and CRP in the Diagnosis and Treatment of Tuberculosis Infection in Children with Tuberculosis T

Objective To analyze the application value of T cell spot test (T-SPOT-TB) in the diagnosis of tuberculosis infection in children. Methods Random selection from January 2014 to July 2015, 90 children with tuberculosis and non tuberculosis pulmonary disease in children in Fuzhou, Fujian Province, province, including 47 cases (A Group) of tuberculosis and 43 cases (B Group) of non tuberculous lung diseases. Using SPSS18.0 software was used for statistical analysis, using the C2 test comparison T-SPOT-TB and acid fast bacilli in sputum smear, Mycobacterium tuberculosis culture, tuberculosis antibody and PPD test, comparison of the test results, P< 0.05, the difference was statistically significant. At the same time of two groups of children of C-reactive protein (CRP) determination. Analysis the significance of CRP in differential diagnosis of tuberculosis. Results T-SPOT-TB in diagnosis of tuberculosis sensitivity was 87.2%(47), the specificity was 97.7% (42 / 43), the PPD test in the diagnosis of tuberculosis sensitivity for 48.9% (23 / 47) and specificity for 67.4%, compared with the positive rate of PPD test. The sensitivity and specificity of T-SPOT-TB in diagnosis of tuberculosis were higher than that of PPD test, the differences were statistically significant (χ2=11.15, 11.07, P<0.05). Positive rate was 87.2%in the tuberculosis in children with T-SPOT-TB detection, significantly higher than that of tuberculosis antibody detection, acid fast bacilli smear, Mycobacterium tuberculosis culture, the differences were statistically significant (χ2=25.03, 31.03, 16.41, P<0.05). The mean value of CRP in the tuberculosis group was (33.09±19.96), and the average value of the non tuberculosis group was (26.79±18.13). There was no significant difference between the two groups (P > 0.05). Conclusion T-SPOT-TB test has high sensitivity and specificity. It is a rapid and sensitive method for diagnosis of children with tuberculosis. It has important application value in early diagnosis of children with tuberculosis. C reactive protein in tuberculosis can be increased, but the simple C reactive protein determination is not significant in the differential diagnosis of tuberculosis and non tuberculous disease.