结核感染T细胞斑点试验对肺结核病的临床诊断价值研究

目的：评价结核感染T细胞斑点试验（T-SPOT．TB）对肺结核病的临床诊断价值。方法：选择2012年2月～8月湘雅医院呼吸科住院病人中92例可疑肺结核患者进行T—SPOT．TB检测、结核菌素试验（PPD试验）、结核抗体、血沉及影像学检查及病史收集。分析和比较T．SPOT．TB与传统结核诊断方法的阳性率、特异度、灵敏度并对其检测结果进行相关性分析。结果：92例患者中，48例被确诊为肺结核，其中41例T．SPOT．TB结果阳性，44例非肺结核患者中5例T．SPOT．TB结果阳性。T—SPOT．TB检测的敏感度为85．4％，特异度为88．6％。T-SPOT．TB检测在结核组的阳性检出率（85．4％）显著高于传统检查方法PPD（37．5％，P〈0．01）、结核抗体（16．7％，P〈0．01）、血沉（66．7％，P〈0．05），在非结核病组中的特异性（88．6％）显著高于血沉（36．6％，P〈0．0J）。PPD与T-SPOT．TB联合可提高诊断结核的阳性率（89．6％）。T．SPOT．TB检测仅与PPD试验的结果存在显著性差异（P〈0．05）。结论：T-SPOT．TB诊断肺结核的敏感性及特异性较传统的PPD实验、结核抗体更高，具有重要的I临床应用价值。

Diagnostic Value of T-SPOT.TB Assay in Pulmonary Tuberculosis

Objective： To evaluate the diagnostic value of T-SPOT.TB assay in pulmonary tuberculosis. Methods： A retrospective study enrolling 92 inpatients of respiratory department with suspected pulmonary tuberculosis was conducted. T-SPOT.TB, PPD skin test, tuberculosis antibody, erythrocyte sedimentation rate and radiographic examination were checked. The diagnostic positive rate, specifici- ty of T-SPOT.TB in pulmonary tuberculosis were evaluated and compared with those traditional TB diagnosis methods. Results： In 92 suspected pulmonary tuberculosis patients, 48 patients were definitely diognosed as TB, in which 41 cases were T-SPOT.TB positive. In 44 patients of the non-TB group, 5 cases were T-SPOT.TB positive. The sensitivity of T-SPOT.TB assay was 85.4% and specificity was 88.6%. As for the sensitivity in discoving TB patient, T-SPOT.TB （85.4%） was significantly superior to those traditional TB diagnosis methods including PPD skin test（37.5%, P〈0.01）, tuberculosis antibody （16.7%, P〈0.01）, erythrocyte sedimentation rate（ESR）（66.7%, P 〈0.05）. The specificity of T-SPOT.TB in non-TB group （88.6%） was significantly superior to the erythrocyte sedimentation rate（36.6%, P 〈0.01）. Combination of PPD skin test and T-SPOT.TB may improve the diagnosis of TB （positive rate was 89.6%）. Consistency analysis was conducted between T-SPOT.TB and traditional TB diagnosis methods, the result showed that T-SPOT.TB was only significantly dif- ferent from the PPD skin test （x~-4.646, P=0.031）. Conclusion： The T-SPOT.TB had higher sensitivity and specificity in comparison to traditional TB diagnosis methods, which turned out to have surperior clinical diagnosis value.