结核感染T细胞斑点试验、涂片检查和结核菌素试验在儿童结核病诊断中的价值

目的评价结核感染T细胞斑点试验(T-SPOT.TB)、涂片检查和结核菌素试验(TST)在儿童结核病中的诊断价值。方法对2015年1月—12月299例疑似结核病住院患儿回顾性研究,比较三种检测方法在儿童结核病中的诊断价值。结果 299例患儿中,结核病患儿135例(确诊52例和临床诊断83例),非结核病患儿164例;T-SPOT.TB、涂片检查和TST诊断结核病的灵敏度分别为78.20%、24.24%、42.98%(P<0.001),特异度分别为97.56%、100%、96.52%(P=0.107);约登指数分别为75.76%、24.24%、39.50%;阳性预测值分别为96.30%、100%、96.52%;阴性预测值分别为84.66%、55. 36%、68. 14%。≤5岁组灵敏度T-SPOT.TB、涂片检查、TST分别为67. 35%、20. 83%、51. 28%,> 5岁组分别为84. 52%、38. 67%、26. 19%。在肺结核组及肺外结核组, T-SPOT.TB灵敏度分别为86. 02%、60%,其次为TST 44. 71%、37. 93%,涂片仅为27. 96%、18. 42%。仅肺结核组及含肺结核的多脏器结核组中,T-SPOT.TB灵敏度分别为83. 87%、90. 32%,TST 53. 45%、25. 93%,涂片检查27. 41%、29. 03%。结论 T-SPOT.TB具有较高的灵敏度、特异度、约登指数、阳性预测值及阴性预测值。在不同年龄组、肺结核或肺外结核儿童T-SPOT.TB均有较高的敏感性。

Comparison of T-cell spot test,smear test,and tuberculin test in the diagnosis of tuberculosis in children

Objective To evaluate the diagnostic value of T-cell spot test (T-SPOT.TB), smear test and tuberculin skin test (TST) in tuberculosis of children. MethodA retrospective study was conducted in 299 hospitalized children suspected of tuberculosis from January to December 2015 to compare the diagnostic value of three detection methods in tuberculosis of children. ResultsOf 299 children, 135 had tuberculosis (52 confirmed and 83 clinically diagnosed) and 164 had non-tuberculosis. The sensitivity and specificity of T-SPOT.TB, smear test and TST in the diagnosis of tuberculosis were 78.20%, 24.24% and 42.98%(P<0.001), and 97.56%, 100% and 96.52%(P=0.107), respectively;Yoden index was 75.76%, 24.24% and 39.50%, and positive predictive value was 96.30%, 100% and 96.52%, and negative predictive value was 84.66%, 55.36% and 68.14%, respectively. The sensitivity of T-SPOT.TB, smear test and TST were 67.35%, 20.83% and 51.28% in children<5 years old;and 84.52%, 38.67% and 26.19% in children>5 years old, respectively. In tuberculosis group and extrapulmonary tuberculosis group, the sensitivity of T-SPOT.TB was 86.02% and 60%, and TST 44.71% and 37.93%, and smear test only 27.96% and 18.42% respectively. In pulmonary tuberculosis group and the multi-organ (including lung) tuberculosis group, the sensitivity of T-SPOT.TB was 83.87% and 90.32%, TST 53.45% and 25.93%, and smear test 27.41% and 29.03%, respectively. ConclusionT-SPOT.TB is high in sensitivity, specificity, Yoden index, positive predictive value and negative predictive value. It has higher sensitivity in different age groups, pulmonary tuberculosis and extrapulmonary tuberculosis children.