结核感染T细胞斑点试验联合胸腔积液Xpert MTB/RIF检测诊断结核性胸腔积液的价值

目的评估结核感染T细胞斑点试验（T-SPOT.TB）联合胸腔积液结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF) 在结核性胸腔积液的诊断价值。方法收集胸腔积液患者112例,其中确诊或临床诊断为结核性胸腔积液76例,非结核性胸腔积液36例。所纳入患者治疗前均行胸腔积液T-SPOT.TB、血T-SPOT.TB、胸腔积液Xpert MTB/RIF、胸腔积液腺苷脱氨酶（ADA）检测，并对其检测结果进行分析。结果胸腔积液T-SPOT.TB诊断结核性胸腔积液的敏感度（97.37%,74/76)，高于外周血T-SPOT.TB （76.32%,58/76）、胸腔积液Xpert MTB/RIF（65.79%,50/76）和胸腔积液ADA（28.95%,22/76），差异均有统计学意义（χ2=14.74、25.22、76.45，P<0.01）。胸腔积液Xpert MTB/RIF检测的特异度（100%,36/36）均高于胸腔积液T-SPOT.TB（77.78%,28/36）、外周血T-SPOT.TB（55.56%,20/36）和胸腔积液ADA（50.00%, 18/36），差异均有统计学意义（χ2=6.89、20.57、24.00，P均＜0.01）。胸腔积液T-SPOT.TB和胸腔积液Xpert MTB/RIF联合检测的敏感度（64.47%, 49/76）低于胸腔积液T-SPOT.TB单独检测（97.37%,74/76），差异有统计学意义（χ2=26.63，P<0.01），但特异度由77.78%(28/36)提高至100%(36/36)，差异有统计学意义（χ2=45.82，P<0.01）。结论胸腔积液T-SPOT.TB检测结核性胸腔积液具有较高的敏感度和特异度，胸腔积液T-SPOT.TB和胸腔积液Xpert Mtb/ＲIF联合检测可明显提高诊断的特异度。

The value of T cell spot test combined with pleural fluid Xpert MTB/RIF test in the diagnosis of tuberculous pleural effusion

Objective To evaluate the diagnostic value of t-spot test combined with real-time fluorescence quantitative nucleic acid amplification (Xpert MTB/RIF) in diagnosis of tuberculous pleural effusion. Methods From June 2018 toJune 2019,112 patients with pleural effusion in Anhui province chest hospital were enrolled, including 76 confirmed or clinical diagnostictuberculous pleural effusion casesand 36 non-tuberculous pleural effusion cases. All the included patients were tested with t-spot.tb of pleural effusion, t-spot.tb of blood, Xpert MTB/RIF of pleural effusion and ADA of pleural effusion before treatment. Results The sensitivity of t-spot.tb in the diagnosis of tuberculous pleural effusion (97.37%,74/76) was significantly higher than that of t-spot.tb in peripheral blood (76.32%,58/76), Pleural effusion Xpert MTB/RIF (65.79%,50/76) and ADA (28.95%,22/76) (χ2=14.74, χ2=25.22 and χ2=76.45, P<0.01). The specificity of Xpert MTB/RIF test in pleural effusion (100%, 36/36) was significantly higher than pleural effusion t-spot.tb (77.78%, 28/36), peripheral blood t-spot.tb (55.56%, 20/36) and ADA (50.00%, 18/36) (χ2=6.89, χ2=20.57 and χ2=24.00, P<0.01). The sensitivity of pleural effusion t-spot.tb and Xpert MTB/RIF combined detection (64.47%, 49/76)was significantly lower than that of pleural effusion t-spot.tb alone (97.37%,74/76) (χ2=26.63, P<0.01); but the specificity was significantly increased from (77.78%, 28/36) to (100%, 36/36) (χ2=45.82, P<0.01). Conclusions T-spot TB of pleural effusion has a high sensitivity and specificity for detecting tuberculous pleural effusion. The combined detection of t-spot TB of pleural effusion and Xpert Mtb/RIF of pleural effusion can significantly improve the specificity of diagnosis.