结核感染T细胞斑点试验在骨与关节结核诊断中的价值

目的探讨结核感染T细胞斑点试验(T-SPOT TB)在临床诊断骨与关节结核的应用价值。方法收集154例疑似骨与关节结核患者外周抗凝血标本,依据细菌学检验、病理学结果及临床表现判定有无结核分枝杆菌感染;其中确诊骨与关节结核73例,非结核感染81例,分别进行T-SPOT TB和结核抗体(TB-Ab)检测,并分析T-SPOT TB在骨与关节结核诊断中的敏感度和特异度。结果 73例确诊骨与关节结核中,64例T-SPOT TB阳性;81例非结核中,72例T-SPOT TB阴性;T-SPOT TB检测敏感度为87.67%(64/73),TB-Ab为41.10%(30/73),T-SPOT TB诊断骨与关节结核的敏感度显著高于TB-Ab(P0.001);T-SPOT TB检测特异度为88.89%(72/81),TB-Ab为71.60%(58/81),T-SPOT TB特异度也高于TB-Ab(P=0.006)。在结核组中,涂阳与涂阴两组T-SPOT TB阳性检出率分别为95.45%(21/22)及86.49%(32/37),差异无统计学意义(P0.05)。在结核组中,病理诊断阳性率92.16%(47/51)与T-SPOT TB总阳性率87.67%(64/73)比较差异无统计学意义(P0.05)。结论 T-SPOT TB在诊断骨与关节结核中具有良好的敏感度和特异度,具有重要临床应用价值。

Diagnostic value of tuberculous infection of T cells spot test for osteoarticular tuberculosis

Objective To investigate the diagnostic value of T cells spot test tuberculosis( T-SPOT TB) in patients with osteoarticular tuberculosis. Methods One hundred and fifty-four suspected osteoarticular tuberculosis anticoag-ulant samples were collected. The diagnosis of TB was confirmed by microbiological results, pathological findings and clinical manifestations. Seventy-three confirmed osteoarticular tuberculosis and 81 confirmed nontuberculosis. The T-SPOT TB and tuberculosis antibody ( TB-Ab) were checked in these patients. The sensitivity and specificity of T-SPOT TB in osteoarticular tuberculosis were evaluated. Results A total of 64 out of 73 cases were T-SPOT TB assay positive in the tuberculosis group,whereas 72 out of 81 cases were T-SPOT TB assay negative in the nontuberculosis group. The diagnostic sensitivity of the T-SPOT TB and TB-Ab were 87. 67%(64/73) and 41. 10%(30/73). The diagnostic specificity of the T-SPOT TB and TB-Ab were 88. 89%( 72/81 ) and 71. 60%( 58/81 ) . The sensitivity and specificity of the T-SPOT TB were both significantly higher than TB-Ab (P<0. 01,P=0. 006). The positive rate of T-SPOT TB assay in sputum smear-positive and sputum smear-negative osteoarticular tuberculosis were 95. 45%(21/22) and 86. 49%(32/37) respectively with no significant difference (P>0. 05). In osteoarticular tuberculosis group, the positive rate of pathological diagnosis was 92. 16%(47/51), which had no significant difference with the positive rate of T-SPOT TB [87. 67%(64/73), P>0. 05]. Conclusions T-SPOT TB has satisfactory sensitivity and specificity in diagnosing osteoarticular tuberculosis, which may have an important role in clinical diagnosis of os-teoarticular tuberculosis.