结核感染T细胞斑点试验在恶性肿瘤并发结核病患者中的应用价值

目的 分析结核感染T细胞斑点试验(T-SPOT.TB)检测恶性肿瘤并发结核病患者的应用价值。方法 选取西安市胸科医院2016年1—12月期间收治确诊的恶性肿瘤并发结核病的患者102例、恶性肿瘤患者64例、单纯结核病患者80例。抽取研究对象外周血并分离出外周血单个核细胞(PBMC),分析T-SPOT.TB检测不同人群的结果。同时分析T-SPOT.TB检测恶性肿瘤并发结核病患者的敏感度和特异度,及其与抗酸染色和(或)病理检查结果的一致性。结果 T-SPOT.TB检测恶性肿瘤并发结核病组阳性率为85.29%(87/102),检测恶性肿瘤组的阳性率为26.56%(17/64),差异有统计学意义(χ ²=57.97,P<0.01);检测单纯结核病组的阳性率为91.25%(73/80),与恶性肿瘤并发结核病组比较,差异无统计学意义(χ ²=1.50,P=0.221);进一步比较A、B抗原反应点数,恶性肿瘤并发结核病组与单纯结核病组患者A抗原阳性斑点数的中位数(四分位数:Q₁,Q₃)分别为56.50(30.25,83.25)个和45.50(32.00,75.00)个;B抗原阳性斑点数的中位数(四分位数:Q₁,Q₃)分别为63.50(43.25,98.00)个和55.00(24.00,101.50)个,两组比较差异均未见统计学意义(Z值分别为-0.66和-0.30,P值分别为 0.539和0.796)。T-SPOT.TB 检测恶性肿瘤并发结核病患者的敏感度和特异度分别为85.29%(87/102)和73.44%(47/64);与抗酸染色和(或)病理检查比较,T-SPOT.TB检测的Kappa值为0.61。 结论 T-SPOT.TB检测对恶性肿瘤并发结核病患者有较好的检测效能,可用于辅助诊断。

The application value of T-SPOT.TB in patients with malignant tumor complicated with tuberculosis

Objective To analyze the clinical application value of T-SPOT.TB in detecting malignant tumor complicated with tuberculosis. Methods From January to December 2016, 102 patients with malignant tumor complicated with tuberculosis, 64 with malignant tumor, and 80 with tuberculosis were selected from Xi’an Chest Hospital. Peripheral blood mononuclear cells (PBMC) were isolated from the peripheral blood of each patient, and the performances of T-SPOT.TB in detecting different patient populations were analyzed. At the same time, the sensitivity and specificity of T-SPOT.TB in detection of malignant tumor complicated with tuberculosis were tested, as well as the consistency with acid-fast staining and/or pathological examination. Results The positive rate of T-SPOT.TB in detecting malignant tumor complicated with tuberculosis was 85.29% (87/102), and the positive rate in detecting malignant tumor was 26.56% (17/64); the difference was statistically significant (χ ²=57.97, P<0.01). The positive rate in detecting tuberculosis was 91.25% (73/80), and there was no statistical significance compared with that of malignant tumor complicated with tuberculosis (χ ²=1.50, P=0.221). Furthermore, the positive spot numbers of A and B antigen in different patient were also compared. For the patients with malignant tumor complicated with tuberculosis and those with tuberculosis only, the median (Q₁, Q₃) positive spot number of A antigen was 56.50 (30.25, 83.25) and 45.50 (32.00, 75.00), and that of B antigen was 63.50 (43.25, 98.00) and 55.00 (24.00, 101.50), respectively. The differences between the two patient populations had no statistical significance (Z=-0.66 and -0.30, P=0.539 and 0.796, respectively). The sensitivity and specificity of T-SPOT.TB for malignant tumor complicated with tuberculosis were 85.29% (87/102) and 73.44% (47/64), respectively. Compared with acid fast staining and/or pathological examination, the Kappa value of T-SPOT.TB was 0.61. Conclusion T-SPOT.TB has good detection efficiency for patients with malignant tumor complicated with tuberculosis, which can be used for auxiliary diagnosis.