T-SPOT.TB在结核病诊断中的应用评价

发布时间：2018-03-06 21:16

  本文选题：活动性结核病　切入点：结核抗体　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：背景近年来随着结核病基础研究的迅速发展,在免疫学检测方面已先后开展了一些较为可靠的结核病检测方法,尤其近年研发的一种新技术——结核感染T细胞斑点试验(T-SPOT.TB),已在许多欧美国家得到认可并被应用于临床诊断。但在我国由于存在较高的结核潜伏感染率,对于此种检测方法在结核病诊断中的应用仍存在争议,因此我们进行以下研究来进一步评价T-SPOT.TB在结核病诊断中的应用价值。目的通过将T-SPOT.TB分别与血清结核抗体检测、皮肤结核菌素试验在疑诊活动性结核病患者中的检测结果进行比较分析,并比较活动性结核患者与结核潜伏感染者T-SPOT.TB阳性结果的斑点数,来评价T-SPOT.TB在结核病诊断中的应用价值。方法前瞻性纳入2013年3月至2013年11月新乡医学院第一附属医院住院患者中疑诊活动性结核病的患者167例,进行T-SPOT.TB、血清结核抗体、结核菌素试验检测。依据辅助检查结果、临床疗效观察及长时间随访结果等依据最终确定诊断,将上述三项检测结果与最终临床诊断相对比,以敏感性、特异性、阳性似然比、阴性似然比、符合率、阳性预测值、阴性预测值为评价指标,将T-SPOT.TB分别与血清结核抗体、皮肤结核菌素试验进行比较。分别分析年龄、营养不良及重症结核对T-SPOT.TB敏感性的影响。统计活动性结核患者与结核潜伏感染者T-SPOT.TB阳性结果斑点数并进行比较分析。结果(1)T-SPOT.TB、吉核抗体检测、结核菌素试验的敏感性分别为90%、28%、55%,T-SPOT.TB分别与另两项检测方法相比,差异有统计学意义(P0.001)(2)T-SPOT.TB、结核抗体检测、结核菌素试验的特异性分别为81.3%、79.1%、76.9%, T-SPOT.TB分别与另两项检测方法相比,差异无统计学意义(PO.05)。(3) T-SPOT.TB、结核抗体检测、结核菌素试验的阳性似然比分别为4.813、1.34、2.38,阴性似然比分别为0.12、0.91、0.59,T-SPOT.TB的阳性似然比最高,阴性似然比最低。(4) T-SPOT.TB、结核抗体检测、结核菌素试验符合率分别为84.8%、58.9%、68.2%, T-SPOT.TB分别与另两项检测方法相比,差异有统计学意义(P0.05)。(5) T-SPOT.TB、结核抗体检测、结核菌素试验的阳性预测值分别为76%、47%、61%, T-SPOT.TB与结核抗体检测相比存在统计学差(P0.05),与结核菌素试验相比无统计学差异(PO.05)。(6) T-SPOT.T B、结核抗体检测、结核菌素试验的阴性预测值分别为93%、62.6%、72.7% 。 T-SPOT.TB分别与另两项检测方法相比,差异有统计学意义(PO.001)。(7)营养不良组与无营养不良组、老年组与非老年组、重症结核组与非重症结核组T-SPOT.TB敏感性比较均无统计学差异(P0.05)。(8)活动性结核患者与结核潜伏感染者T-SPOT.TB阳性结果抗原A孔斑点中位数分别为21与14,二者比较无统计学差异(P0.05),抗原B孔斑点数中位数分别为25与3,二者比较有统计学差异(PO.05)结论T-SPOT.TB是一种诊断结核病的较好方法,阴性结果对排除活动性结核病的诊断价值较高。阳性结果对判断结核是否活动作用有限。
[Abstract]:Background with the rapid development of basic research on tuberculosis in recent years, some reliable methods of tuberculosis detection have been carried out in immunology. In particular, a new technique developed in recent years-T-SPOT.TBX, has been recognized in many European and American countries and has been used in clinical diagnosis. However, because of the high latent infection rate of TB in China, The application of T-SPOT.TB in the diagnosis of tuberculosis is still controversial, so we do the following research to further evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. The results of skin tuberculin test in suspected active tuberculosis patients were compared, and the number of T-SPOT.TB positive spots in active tuberculosis patients and latent tuberculosis patients were compared. To evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. Methods from March 2013 to November 2013, 167 patients with suspected active tuberculosis were included in the first affiliated Hospital of Xinxiang Medical College. According to the results of auxiliary examination, clinical efficacy observation and long-term follow-up, the final diagnosis was determined. The results of the above three tests were compared with the final clinical diagnosis, with sensitivity, specificity, positive likelihood ratio, etc. Negative likelihood ratio, coincidence rate, positive predictive value and negative predictive value were evaluated. T-SPOT.TB was compared with serum tuberculosis antibody and skin tuberculin test. Effects of malnutrition and severe tuberculosis on T-SPOT.TB susceptibility. The number of T-SPOT.TB positive spots in active TB patients and latent TB patients were analyzed and compared. The sensitivity of the tuberculin test was 90%. The sensitivity of the TSPOT.TB test was significantly higher than that of the other two methods. The specificity of the TB antibody test was 81.3% and 79.1%, respectively, and the T-SPOT.TB test was compared with the other two methods, respectively, and the specificity of the tuberculin test was 79.9%. The T-SPOT.TB test was compared with the other two methods. There was no significant difference in T-SPOT.TB. the positive likelihood ratio of tuberculin test was 4.8131.34 ~ 2.38, and the negative likelihood ratio was 0.120.91 ~ 0.59% T-SPOT.TB was the highest, and the negative likelihood ratio was the lowest) T-SPOT.TB, TB antibody test, TB antibody test, T-SPOT.TB, TB antibody test, the positive likelihood ratio of T-SPOT.TB was the highest, the negative likelihood ratio was the lowest, and the positive likelihood ratio of TB antibody test was 4.8131.34, and the negative likelihood ratio of T-SPOT.TB was the highest and the lowest. The coincidence rates of tuberculin test were 84.8% and 58.9%, respectively. Compared with the other two methods, T-SPOT.TB was significantly different from the other two methods. The positive predictive values of the tuberculin test were 76 and 4761.The T-SPOT.TB was significantly lower than the tuberculosis antibody test (P0.05), and there was no statistical difference compared with the tuberculin test (P < 0.05. 0. 6) T-SPOT.TB. The negative predictive values of tuberculin test were 93.62.6% and 72.7%, respectively. T-SPOT.TB was significantly different from the other two methods (P < 0.01). There was no significant difference in the sensitivity of T-SPOT.TB between the patients with severe tuberculosis and those with non-severe tuberculosis (P 0.05. 05). The median of T-SPOT.TB positive results of T-SPOT.TB positive spots in active TB patients and latent TB patients was 21 and 14, respectively. There was no significant difference between the two groups. The median number of antigenic B hole spots was 25 and 3, respectively (P < 0.05). Conclusion T-SPOT.TB is a better method for the diagnosis of tuberculosis. The negative results were of high diagnostic value in excluding active tuberculosis, and the positive results were of limited value in judging whether tuberculosis was active or not.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R52
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本文编号：1576536