结核分枝杆菌T细胞检测（T-SPOT.TB）对活动性结核的诊断价值

发布时间：2018-02-21 17:35

本文关键词： 结核分枝杆菌结核分枝杆菌T细胞检测活动性结核 ROC曲线　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景和目的WHO 2015年全球结核病报告中提出全球结核病发病率自2000年来下降了18%,平均每年下降1.5%。死亡率自1990年以来下降了47%。尽管取得了巨大成就,结核病在全球范围仍然是最严重的公共卫生威胁。2014年结核病在全球范围死亡人数为150万,近960万新发病例我国。我国是世界上结核病发病率最高的国家之一,仅次于印度,排名第二。其诊断困难,治疗时间长,严重影响着人们的日常生活。以前结核病的诊断往往依靠于PPD试验,但是其有许多局限性,近年来,新型的诊断结核菌感染的手段——结核分枝杆菌T细胞检测(T-SPOT.TB),为MTB感染的诊断带来的新的方法,本研究即探讨T-SPOT.TB对活动性结核的诊断意义。研究方法回顾性分析2015年6月-2016月6日在河南省人民医院呼吸科住院期间疑似活动性结核病的病人,总共450例。收集其一般情况资料,并根据诊断将患者分为活动性结核病组、陈旧性结核病组和非结核病组,评价T-SPOT.TB的灵敏度、特异度、阴性预测值、阳性预测值、阳性似然比、阴性似然比及约登指数(Youden′s Index)。绘制其诊断的ROC曲线,探索最优的诊断界值。比较T-SPOT.TB的A抗原和B抗原数值在各组间是否存在的差异。研究结果诊断活动性肺结核的灵敏度89.39%,特异度为63.03%,阳性预测值0.55,阴性预测值0.92,阳性似然比2.42,阴性似然比0.17,约登指数(Youden′s Index)0.52。在T-SPOT.TB诊断活动性结核的ROC曲线中,A抗原的曲线下面积(0.89)大于B抗原(0.86),在A抗原取值为13.5 SFCs/2.5*105PBMC时,诊断价值最优,约登指数(Youden′s Index)为0.71,灵敏度为84.10%,特异度为86.50%。T-SPOT.TB在诊断陈旧性肺结核的ROC曲线中,A抗原和B抗原的曲线下面积为0.60、0.58,诊断价值差。其中A抗原、B抗原数值在活动性结核病组分别与非结核病组、陈旧性肺结核组组间有统计学差异(A抗原χ2=105.41、P㩳0.01,B抗原χ2=91.03、P㩳0.01;A抗原χ2=12.99、P㩳0.01,B抗原χ2=8.56、P㩳0.01),在非结核病组与陈旧性肺结核组间无统计学差异(A抗原χ2=1.07、P㧐0.05,B抗原χ2=0.77、P㧐0.05)。既往卡介苗接种史对假阳性的发生没有统计学意义(P㩳0.05),年龄"g65岁、免疫力下降或低下、体重指数(BMI)㩳16.0 kg/m2这些因素与假阴性的发生有统计学意义(P㩳0.05)。结论T-SPOT.TB对活动性结核的诊断具有较高的灵敏度和特异度,能为活动性结核的诊断提供重要参考价值,不受既往结核病史和接种卡介苗的影响。
[Abstract]:Background and objective the WHO Global TB report of 2015 states that the global incidence of tuberculosis has dropped by 18 per cent since 2000, with an average annual decline of 1.5 per year. The mortality rate has fallen by 47 per cent since 1990. Tuberculosis is still the most serious public health threat in the world. In 2014, the death toll of tuberculosis in the world was 1.5 million, nearly 9.6 million new cases in China. China is one of the countries with the highest incidence of tuberculosis in the world, second only to India. Second place. Its diagnosis is difficult, the treatment time is long, seriously affects people's daily life. In the past, the diagnosis of tuberculosis often depended on PPD test, but it has many limitations, in recent years, A new method for the diagnosis of tuberculous infection-Mycobacterium tuberculosis T cell detection of T-SPOT.TBX, which brings a new method for the diagnosis of MTB infection. The purpose of this study was to investigate the diagnostic significance of T-SPOT.TB in active tuberculosis. Methods A retrospective analysis was made on the patients suspected of active tuberculosis during their stay in the Department of Respiratory Medicine of Henan Provincial people's Hospital from June 2015 to 6th. The patients were divided into active tuberculosis group, old tuberculosis group and non-tuberculosis group according to the diagnosis. The sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio of T-SPOT.TB were evaluated. The negative likelihood ratio and the Jorden index were used to draw the ROC curve for the diagnosis. To explore the best diagnostic boundary value. To compare the difference between T-SPOT.TB A antigen and B antigen value in each group. The sensitivity of diagnosis of active pulmonary tuberculosis is 89.39, the specificity is 63.03, the positive predictive value is 0.55, the negative predictive value is 0.92, and the positive predictive value is 0.92, the positive predictive value is 0.92, the positive predictive value is 0.52, and the positive predictive value is 0.92. The likelihood ratio was 2.42, the negative likelihood ratio was 0.17, and the Yorden index was YoudensIndex0.52. In the ROC curve of T-SPOT.TB for the diagnosis of active tuberculosis, the area under the curve of A antigen was 0.89), which was larger than that of B antigen 0.860.When A antigen was obtained, the value of A antigen was 13.5 SFCs/2.5*105PBMC. Diagnostic value is optimal, The Yorden index was 0.71, the sensitivity was 84.100.The specificity of T-SPOT.TB was 86.50.T-SPOT.TB in the ROC curve for the diagnosis of old pulmonary tuberculosis, the area under the curve of A antigen and B antigen was 0.600.58, the diagnostic value of A antigen B antigen was poor in active tuberculosis. Group and non-tuberculosis group, There was statistical difference between the old pulmonary tuberculosis group and the other group. 0.01mb antigen 蠂 2: 91.03P? 0.01A antigen 蠂 ~ 2 ~ (12.99) P? 0.01mb antigen 蠂 ~ 2 ~ (8.56) P? There was no statistical difference between non-tuberculosis group and old pulmonary tuberculosis group. 0. 05? B antigen 蠂 2? The history of BCG vaccination had no statistical significance in the occurrence of false positive. 0. 05%, age "g65 years old, immunity impaired or low, body mass index (BMI) BMIG?" 16. 0 kg/m2, these factors were significantly associated with the occurrence of false negative. Conclusion T-SPOT.TB has high sensitivity and specificity in the diagnosis of active tuberculosis, which can provide an important reference value for the diagnosis of active tuberculosis and is not affected by previous tuberculosis history and BCG vaccination.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52

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