T-SPOT.TB与PPD在消化系统结核感染鉴别诊断中的价值

目的评估快速T细胞计数体外酶联免疫斑点技术(T-ELISPOT.tuberculosis,T-SPOT.TB)与PPD试验在消化系统结核感染的诊断价值。方法回顾性分析2011年6月-2013年7月于南京军区南京总医院消化内科收治的60例患者,其中14例确诊为结核感染的患者,46例为非结核感染的消化系统疾病患者,抽取患者外周血送检,T-SPOT.TB与PPD试验结果的准确性进行比较。结果 14例确诊结核感染患者,46例非结核感染的患者,T-SPOT.TB的灵敏度与PPD试验相近,差异无统计学意义(78.6%vs71.4%,P=1.000);T-SPOT.TB的特异性显著大于PPD试验(91.3%vs 69.6%,P=0.009);T-SPOT.TB阳性预测率显著大于PPD试验(73.3%vs 41.7%,P=0.001);T-SPOT.TB阴性预测率与PPD试验相近,差异无统计学意义(93.3.%vs 91.1%,P=1.000)。T-SPOT.TB与PPD试验在诊断消化系统结核感染方面有较好的吻合性(K=0.341,P=0.018)。结论 T-SPOT.TB应用于消化系统感染的诊断,尤其适合PPD阳性的疑似消化系统结核感染患者的鉴别诊断。

Value of T-SPOT. TB assay and tuberculin PPD skin test in differential diagnosis of patients with latent tuberculosis infection of digestive system

Objective To evaluate the value of the T-SPOT. TB and tuberculin PPD skin test in diagnosis of latent tuberculosis infection of digestive system. Methods All 60 patients were suspected tuberculosis of digestive system from Jun. 2011 to Jul. 2013. Fourteen cases were diagnosed as tuberculosis, 48 cases were excluded tuberculosis, the accura- cy of T-SPOT. TB （ELISPOT） in diagnosis of tuberculosis of digestive system was estimated. The conventional diagnos- tic tool （PPD skin test） was used as controls. Results Tuberculosis of digestive system were confirmed in 14 cases of 60 patients suspected tuberculosis of digestive system. T-SPOT. TB was excluded in the remaining 46 patients. The sen- sitivity of T-SPOT. TB showed similar to PPD skin test （78.6% vs 71.4% , P = 1. 000） ; the specificity of T-SPOT. TB was higher than that of PPD skin test （ 91.3% vs 69.6% , P = 0. 009） ; the positive predictive rate of T-SPOT. TB was greater than that of PPD skin test （73.3% vs 41.7% , P =0. 001 ） ; the negative predictive rates of two tests were simi- lar （93.3.% vs91. 1%, P=1.000）. Agreemen between T-SPOT. TB and PPD skin test was fair （K=0.341, P= 0. 018）. Conclusion T-SPOT. TB may serve as an important tool in diagnosis of tuberculosis of digestive system, espe- cially for patients with positive PPD skin test, suspected tuberculosis of digestive system.