T细胞斑点试验在结核性脑膜炎诊断中的应用价值

目的分析结核感染T细胞斑点试验(T-SPOT.TB)在结核性脑膜炎诊断中的应用价值。方法以2017年1月-2019年12月安徽省胸科医院收治的93例脑膜炎患者为研究对象,其中确诊或临床诊断为结核性脑膜炎62例,非结核性脑膜炎31例。所有入组患者治疗前均检测外周血T-SPOT.TB,脑脊液腺苷脱氨酶(ADA)、结核分枝杆菌DNA(TBDNA)、抗酸杆菌(AFB)涂片,对试验结果进行分析。结果外周血T-SPOT.TB检测诊断结核性脑膜炎的灵敏度为82.3%(51/62),特异度为80.7%(25/31),灵敏度明显高于脑脊液ADA(61.3%,38/62)、脑脊液TB-DNA(27.4%,17/62)、脑脊液AFB涂片(16.1%,10/62),差异均有显著统计学意义(P<0.01)。采用受试者工作特征(ROC)曲线及其曲线下面积(AUC)来分析不同试验方法的诊断价值,外周血T-SPOT.TB、脑脊液ADA、脑脊液TB-DNA和脑脊液AFB涂片的AUC值分别为0.815、0.661、0.637、0.581。外周血T-SPOT.TB在结核性脑膜炎中的诊断效能最高。结论外周血T-SPOT.TB在结核性脑膜炎的诊断中,可作为可靠的辅助参考指标之一。

Utility of T-cell spot test in the diagnosis of tuberculous meningitis

Objective To examine the utility of T cell spot test in the diagnosis of tuberculous meningitis.Methods From January 2017 to December 2019,93 cases of meningitis were treated in Anhui Chest Hospital,including 62 cases of tuberculous meningitis and 31 cases of non-tuberculous encephalitis.All patients received peripheral blood T-SPOT.TB,adenosine deaminase(ADA),Mycobacterium tuberculosis DNA(TB-DNA),and acid fast bacilli(AFB)smear of cerebrospinal fluid(CSF)before treatment.Results Peripheral blood T-SPOT.TB displayed the sensitivity of 82.3%(51/62)and specificity of 80.7%(25/31)in the diagnosis of tuberculous meningitis.The sensitivity was significantly higher than that of ADA(61.3%,38/62),TB-DNA(27.4%,17/62),and AFB smear(16.1%,10/62)in CSF(all P<0.01).The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the diagnostic value of different test methods.The AUC value of peripheral blood T-SPOT.TB,ADA,TB-DNA and AFB smear in CSF was 0.815,0.661,0.637,and 0.581,respectively.Peripheral blood T-SPOT.TB showed the best performance in the diagnosis of tuberculous meningitis.Conclusions Peripheral blood T-SPOT.TB can be used as a reliable tool for diagnosis of tuberculous meningitis.