三种快速实验室检测技术在儿童结核性脑膜炎早期诊断中的价值

目的评价三种快速实验室检测技术对儿童结核性脑膜炎的早期诊断价值。方法收集沈阳市胸科医院2017年6月～2019年12月收治的疑诊儿童结核性脑膜炎病例52例,分别进行血T-SPOT.TB、脑脊液LAMP和脑脊液Xpert MTB/RIF检测。结果采用SPSS18.0软件进行统计分析,计算三种检测方法在诊断结核性脑膜炎的敏感度、特异度、阳性预测值、阴性预测值、一致率。结果在52例患者中,血T-SPOT.TB诊断结核性脑膜炎的敏感度为93.75%,特异度8.33%,阳性预测值31.25%,阴性预测值75.00%,一致率34.62%。脑脊液LAMP诊断结核性脑膜炎的敏感度为81.25%,特异度75.00%,阳性预测值59.09%,阴性预测值90.00%,一致率76.92%。脑脊液Xpert MTB/RIF诊断结核性脑膜炎的敏感度为87.50%,特异度88.89%,阳性预测值77.78%,阴性预测值94.12%,一致率88.46%。结论血T-Spot、脑脊液LAMP和脑脊液Xpert MTB/RIF检测对儿童结核性脑膜炎的早期诊断具有一定的价值,值得临床推广。

The value of three rapid laboratory testing techniques in the early diagnosis of pediatric tuberculous meningitis

Objective To evaluate the value of three rapid laboratory testing techniques for early diagnosis of pediatric tuberculous meningitis.Methods 52 cases of suspected pediatric tuberculous meningitis who were admitted to Shenyang Chest Hospital from June 2017 to December 2019 were collected.Blood T-SPOT.TB,cerebrospinal fluid LAMP and cerebrospinal fluid Xpert MTB/RIF were tested respectively.The results were statistically analyzed using SPSS18.0 software.The sensitivity,specificity,positive predictive value,negative predictive value,and agreement rate of the three detection methods in the diagnosis of tuberculous meningitis were calculated.Results In 52 patients,the sensitivity of blood T-SPOT.TB for diagnosis of tuberculous meningitis was 93.75%,specificity was 8.33%,positive predictive value was 31.25%,negative predictive value was 75.00%,and agreement rate was 34.62%.The sensitivity of cerebrospinal fluid LAMP in the diagnosis of tuberculous meningitis was 81.25%,specificity was 75.00%,positive predictive value was 59.09%,negative predictive value was 90.00%,and agreement rate was 76.92%.The sensitivity of cerebrospinal fluid Xpert MTB/RIF for the diagnosis of tuberculous meningitis was 87.50%,specificity was 88.89%,positive predictive value was 77.78%,negative predictive value was 94.12%,and agreement rate was 88.46%.Conclusion The detection of blood T-Spot,cerebrospinal fluid LAMP and cerebrospinal fluid Xpert MTB/RIF has a certain value for the early diagnosis of pediatric tuberculous meningitis,which is worthy of clinical promotion.