T-SPOT．TB 和 ADA 在结核性胸膜炎中的诊断价值

目的：评价外周血结核杆菌感染 T 细胞斑点试验（T-SPOT．TB）和胸腔积液腺苷脱氨酶（ADA）检测对结核性胸膜炎的辅助诊断价值。方法前瞻性纳入疑诊结核性胸膜炎患者62例，进行外周血 T-SPOT．TB、胸腔积液 ADA 检测，利用 ROC曲线探讨胸腔积液 ADA 诊断结核性胸膜炎的最佳临界值。结果根据诊断及分组标准，最终诊断结核性胸膜炎24例，非结核性胸膜炎33例，无法确定者5例，外周血 T-SPOT．TB 诊断结核性胸膜炎的灵敏度为91．7％，特异度为81．8％，阳性预测值78．6％，阴性预测值93．1％；结核性胸膜炎组 ADA 活性为（40．5±15．4）IU/L，非结核性胸膜炎组 ADA 活性为（12．4±9．5）IU/L，差异有统计学意义（P ＜0．01）；将 ADA 活性的临界值定为22．5 IU/L，其灵敏度和特异度分别为83．3％和84．8％；联合 T-SPOT．TB 与 ADA 检测灵敏度为95．8％。结论外周血 T-SPOT．TB 联合胸腔积液 ADA 对诊断结核性胸膜炎具有较高的灵敏度，对疑似结核性胸膜炎患者的快速、准确诊断具有重要的辅助诊断价值。

The diagnostic value of T-SPOT.TB and ADA for tuberculous pleurisy

Objective To evaluate the diagnostic value of peripheral blood T-SPOT.TB and pleural effusion′s adenosine deami-nase（ADA）activity in patients with tuberculous pleurisy.Methods Sixty-two patients with suspected tuberculous pleurisy were enrolled in the study,whose peripheral blood T-SPOT.TB and pleural effusion ADA were measured and the best diagnostic thresh-old was determined by ROC curve.Results According to the diagnostic criteria of tuberculous pleurisy,24 patients were diagnosed with tuberculous pleurisy,33 were non-tuberculous pleurisy and 5 undiagnosed in the end.The sensitivity of T-SPOT.TB for the diagnosis of tuberculous pleurisy was 91.7 %,the specificity was 81.8%,Positive predictive value was 78.6%,negative predictive value was 93.1%.The ADA activity was （40.5±15.4）IU/L in tuberculous pleurisy group,which was higher than in non tubercu-lous pleurisy group[（2.4 ±9.5 ）IU/L]（P 〈0.01 ）.The cut-off value of ADA was 22.5 IU/L in tuberculous pleurisy diagnosis, while its sensitivity and specificity were 83.3% and 84.8% respectively.The sensitivity of the combined detection of T-SPOT.TB and ADA was 95.8%.Conclusion The combined detection of peripheral blood T-SPOT.TB and pleural effusion ADA has a higher sensi-tivity in diagnosis of tuberculous pleurisy,and has important auxiliary diagnostic value for patients with suspected tuberculous pleurisy.