比较四种实验室辅助检查方法在肺结核诊断中的应用价值

目的 评价结核感染T淋巴细胞斑点试验(T-SPOT)、荧光PCR、抗结核抗体试验、抗酸染色四种辅助检查方法对于肺结核诊断的应用价值。方法 回顾性分析2012年1月～2014年12月期间530例同时进行上述四项检查的病例,以临床诊断为金标准,计算四种方法的敏感度、特异度、阳性预测值、阴性预测值、Kappa值、约登指数、阳性似然比、阴性似然比等指标,进行四种检测方法之间的配对χ²检验。结果 T-SPOT敏感度95.90%,误诊率14.33%,阴性预测值97.29%,约登指数0.82,均为最高,阴性似然比0.05为最低; PCR漏诊率87.18%为最高; 抗结核抗体阳性似然比6.48为最低; 抗酸染色特异度99.70%,阳性预测值98.90%,阳性似然比153.83均为最高。四种方法间两两比较差异均有统计学意义。结论T-SPOT和抗酸染色可作为重要的辅助检查,抗结核抗体具有高时效的特点,而PCR方法更适用于无菌部位体液的检查。

A Comparative Study on Four Methods in the Diagnosis of Tuberculosis

Objective To evaluate the value of four methodsin diagnosis of pulmonary tuberculosis,including T-SPOT,fluorescent PCR,anti-TB antibody test,and acid-fast staining.Methods Retrospective analysis of 530 cases between January 2012 and December 2014 who hadtaken four methods,and calculated the sensitivity specificity,positive predictive value,negative predictive value,Kappa value,Youden index,positive likelihood ratio,negative likelihood ratio,Paired χ² test.Consider clinicaldiagnosis as the gold standard.Results The sensitivity,negative predictive value,Youden index of T-SPOT were 95.90%,97.29%,0.82,respectively,and all of these were the highest.The negative likelihood ratio of T-SPOT was 0.05,which was the lowest.Misdiagnosis rate of PCR was 87.18%,which was the highest.Positive likelihood of anti-TB antibody test was thelowest,6.48,while other indicators were no advantage.The specificity,positive predictive value and positive likelihood ratio of acid-fast staining were 99.70%,98.90%,153.83,respectively,and the three of these were highest.Pairwise comparison between the four methods were significantly different.Conclusion The T-SPOT and acid-fast staining can be used as important methods,and the anti-TB antibody can provide result quickly,and PCR method is more suitable for examination of sterile body fluids.