结核感染T细胞斑点试验联合外周血血小板计数、血小板–淋巴细胞比值对活动性肺结核与非活动性肺结核的鉴别意义

目的 探讨结核感染T细胞斑点试验（T-SPOT.TB）及外周血血小板计数（PLT）、血小板-淋巴细胞比值（PLR）对活动性肺结核与非活动性肺结核的鉴别意义。方法 回顾性分析宜春市人民医院2019年1月至2021年6月临床病例250例（活动性肺结核患者115例，非活动性肺结核患者63例，非结核性肺炎72例），收集其T-SPOT.TB试验结果、外周血白细胞计数、血小板计数、PLR、细菌抗酸染色等实验室结果和最终诊断，并做统计学分析。结果 非结核肺炎患者T-SPOT.TB阳性率为4.17%，明显低于非活动肺结核患者T-SPOT.TB阳性率（82.54%）和活动性肺结核患者T-SPOT.TB阳性率（85.22%）；活动性肺结核组的血小板计数、PLR均高于非活动性肺结核组及非结核肺炎组。T-SPOT.TB、PLT、PLR多因素logistic回归分析表明，T-SPOT.TB联合PLT、PLR诊断活动性肺结核灵敏度为63.30%，特异度为86.50%。结论 T-SPOT.TB联合PLT、PLR有助于鉴别诊断活动性肺结核与非活动性肺结核，为临床提供是否抗结核治疗的依据。

Significance of T-SPOT.TB and peripheral platelet count and PLR in differential diagnosis of active pulmonary tuberculosis and inactive pulmonary tuberculosis

  Objective  To investigate the significance of T cell spot test of tuberculosis infection (T-SPOT.TB) and peripheral platelet count (PLT) and platelet-lymphocyte ratio (PLR) in the differential diagnosis of active pulmonary tuberculosis (TB) and inactive pulmonary TB.   Methods  A retrospectively analysis was conducted for 250 clinical cases of suspected pulmonary TB, including 115 active pulmonary TB cases, 63 inactive TB cases and 72 non-TB pneumonia cases, in Yichun People's Hospital from January 2019 to June 2021. The laboratory detection results, such as T lymphocyte spot test for TB, PLT, PLR, bacterial acid-antacid staining, and final diagnosis of the cases were collected for statistical analysis.   Results  The positive rate of T-SPOT.TB in the non-TB pneumonia patients (4.17%) was significantly lower than those in the inactive pulmonary TB patients (82.54%) and active pulmonary TB patients (85.22%), the platelet count and PLR in the active pulmonary TB patients were significantly higher than those in the inactive pulmonary TB patients and the non-TB pneumonia patients. The multivariate logistic regression analysis showed that the sensitivity and specificity of T-SPOT.TB combined with PLT and PLR in the diagnosis of active pulmonary TB were 63.30%, and 86.50%.   Conclusion  T-SPOT. TB combined with PLT and PLR is helpful in the differential diagnosis of active pulmonary TB and inactive pulmonary TB, and can provide evidence for clinical anti-TB therapy.