优化T-SPOT. TB在区分脊柱结核与其他脊柱感染中的诊断效能

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)在脊柱结核(STB)鉴别诊断中的效能，并通过受试者工作特征(ROC)曲线最佳截断值优化诊断效能。方法 收集2010年1月—2019年5月某院脊柱感染患者的临床资料，包括术前T-SPOT.TB检测结果、白细胞计数、C-反应蛋白、血沉、降钙素原和结核抗体等相关数据，根据诊断标准进行临床诊断，分析T-SPOT.TB在术前诊断STB与其他脊柱感染中的灵敏度和特异度，评价优化后的T-SPOT.TB指标的诊断效能。结果 共纳入132例患者，其中78例(59.09%)为STB,54例(40.91%)为非结核脊柱感染。T-SPOT.TB在鉴别诊断STB方面的灵敏度为67.68%,特异度为66.67%。单因素logistic回归分析显示，与非结核脊柱感染比较，T-SPOT.TB检测诊断STB的OR值为4.188(95%CI:1.847～9.974,P<0.001)。优化T-SPOT.TB评价指标，通过绘制ROC曲线，确定ESAT-6、CFP-10、CFP-10+ESAT-6在STB和非结核脊柱感染鉴别诊断中的最佳截断值，分别为12.5、19.5...

Diagnostic efficacy of optimized T-SPOT. TB in differentiating spinal tuberculosis from other spinal infection

Objective To explore the efficacy of T-cell spot test of tuberculosis infection (T-SPOT. TB) in the differential diagnosis of spinal tuberculosis (STB), and optimize diagnostic efficacy through the optimal cut-off value of receiver operating characteristic (ROC) curve. Methods Clinical data of patients with spinal infection in a hospital from January 2010 to May 2019 were collected, including preoperative T-SPOT. TB test results, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and tuberculosis antibodies, et al. Clinical diagnosis was conducted based on diagnostic criteria. The sensitivity and specificity of T-SPOT. TB in preoperative diagnosis of STB and other spinal infection was analyzed, and the diagnostic efficacy of the optimized T-SPOT. TB indicators was evaluated. Results A total of 132 patients were included in this study, out of whom 78 patients (59.09%) were diagnosed with STB, and 54 (40.91%) were diagnosed with non-tuberculosis (non-TB) spinal infection. The sensitivity and specificity of T-SPOT. TB in differential diagnosis of STB were 67.68% and 66.67%, respectively. Univariate logistic regression analysis showed that compared with non-TB spinal infection, the OR va-lue of T-SPOT. TB test in diagnosing STB was 4.188 (95%CI: 1.847-9.974, P < 0.001). The optimized T-SPOT. TB evaluation index through ROC curve to determine the optimal cut-off values of ESAT-6, CFP-10, and CFP-10+ESAT-6 for differential diagnosis of STB and non-TB spinal infection were 12.5, 19.5, and 36, respectively, and area under curve (AUC) values were 0.765 6, 0.741 5, and 0.778 6, respectively, all with good diagnostic efficacy. CFP-10+ESAT-6 had the highest AUC. CFP-10+ESAT-6 specific spot count had higher efficacy in the diagnosis of STB, with a diagnostic accuracy of 75.56%, higher than 67.42% of pre-optimized T-SPOT. TB. Conclusion T-SPOT. TB test has high diagnostic efficacy in differentiating STB from non-TB spinal infection. Positivity in T-SPOT. TB test, especially with spot count of CFP-10+ESAT-6 over 36, indicates a higher likelihood of STB.