结核感染T 细胞斑点试验在结核性浆膜炎中的诊断价值研究

目的 探讨浆膜腔积液结核感染T 细胞斑点试验（T-SPOT.TB）检测在结核性浆膜炎诊断中的价值。方法 选取2014 年8 月-2016 年3 月于湖南省长沙市中心医院住院的152 例可疑结核性浆膜炎患者，按最终诊断分为结核组和非结核组，两组行浆膜腔积液的腺苷脱氨酶（ADA）、结核分枝杆菌培养、T-SPOT.TB及结核杆菌脱氧核糖核酸检测（TB-DNA），比较4 种方法在结核性浆膜炎诊断中的敏感性、特异性、阳性预测值及阴性预测值。结果 患者T-SPOT.TB、ADA、TB-DNA 及结核分枝杆菌培养的敏感性分别为88.2%、45.2%、9.8% 和18.6%，特异性分别为86.0%、80.0%、98.0% 和100.0%，阳性预测值分别为92.8%、82.1%、90.9% 和100.0%，阴性预测值分别为78.2%、41.7%、34.8% 和37.6%。T-SPOT.TB 诊断结核性胸膜炎、结核性腹膜炎及结核性心包炎的敏感性比较，差异有统计学意义（P <0.05），T-SPOT.TB 与ADA、TBDNA、结核分枝杆菌培养的敏感性和特异性比较，差异有统计学意义（P <0.05），T-SPOT.TB 检测ROC 曲线面积为0.893（59%CI ：0.834，0.952）。结论 浆膜腔积液T-SPOT.TB 检测比ADA、TB-DNA、结核分枝杆菌培养更适用于诊断结核性浆膜炎。

Value of T-SPOT.TB in diagnosis of tuberculous serositis

Objective To investigate the value of T-SPOT.TB detection in clinical diagnosis of tuberculousserositis. Methods A total of 152 patients of suspected tuberculous serositis in our hospital from August 2014 toMarch 2016 were recruited in the present study. They were divided into TB group (102 patients) and non-TB group(50 patients) according to the final diagnosis. Adenosine deaminase (ADA), Mycobacterium tuberculosis DNA (TBDNA)and T-SPOT.TB of the effusion were detected, and Mycobacterium tuberculosis (TB) culture was made. Thesensitivity, specificity, positive predictive value and negative predictive value of the 4 methods for the diagnosisof tuberculous serositis were compared in the two groups. Results Regarding the four methods of T-SPOT.TB,ADA, TB-DNA and TB culture, the sensitivity was 88.2%, 45.2%, 9.8% and 18.6% respectively, the specificity was86.0%, 80.0%, 98.0% and 100.0% respectively, the positive predictive value was 92.8%, 82.1%, 90.9% and 100.0%respectively, and the negative predictive value was 78.2%, 41.7%, 34.8% and 37.6% respectively. The sensitivity ofT-SPOT.TB was different in the diagnosis of tuberculous pleurisy, tuberculous peritonitis and tuberculous pericarditis(P < 0.05); when the sensitivity and specificity of T-SPOT.TB were compared with those of ADA, TB-DNA and TBculture, the differences were all statistically significant (P < 0.05), the area under ROC curve of T-SPOT.TB test was 0.893. Conclusions T-SPOT.TB may be more applicable for diagnosis of tuberculous serositis than ADA, TB-DNAand TB culture.