T-SPOT.TB检测在活动性结核病诊断中的临床应用

发布时间：2018-05-27 21:27

本文选题：活动性结核病 + 酶联免疫斑点技术　；参考：《浙江大学》2014年硕士论文

【摘要】：背景：我国是结核病高发国家,结核病一直是最危及人类健康的传染病之一,传统的结核感染诊断技术如痰找抗酸杆菌和TST试验,存在敏感性低及特异性较差的缺点。近年来一种以结核抗原特异性T细胞反应为基础的新的结核病诊断方法,即T-SPOT.TB,已在临床逐步建立与开展起来。但该检测方法的临床应用价值尚缺乏大样本研究。方法及目的：对2012年1月至2012年6月在浙江大学附属第一医院呼吸内科和感染科收治的273例疑诊为活动性结核感染的住院患者进行回顾性分析。这273例患者均进行外周血T-SPOT.TB检测,将T-SPOT.TB检测结果与最终临床诊断进行比较,以敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比为评价指标,探讨T-SPOT. TB在活动性结核病诊断中的应用价值。同时比较T-SPOT.TB、痰找抗酸杆菌和TST试验这三种检测方法敏感性、特异性、阳性预测值、阴性预测值之间的差异。评价T-SPOT.TB、痰找抗酸杆菌和TST试验这三种方法在结核病诊断中不同的应用价值。结果：273例患者最终116例确诊活动性结核病,144例患者排除结核,13例患者仍诊断不明。确诊为活动性结核病的患者中101例T-SPOT.TB结果阳性,敏感性为87.07%。在144例排除活动性结核病诊断的患者中,115例患者T-SPOT.TB检测结果为阴性,特异性为79.86%。阳性预测值为77.69%,阴性预测值88.46%,阳性似然比4.32,阴性似然比0.16。确诊为活动性结核病的患者中,91例为肺结核患者,78例T-SPOT.TB检测阳性,敏感性85.71%；25例肺外结核,23例T-SPOT.TB检测阳性,敏感性为92%。T-SPOT.TB诊断肺外结核的敏感性明显高于肺结核,差异有统计学意义(P0.01) 痰找抗酸杆菌敏感性32.97%,特异性99.04%,阳性预测值96.77%,阴性预测值62.80%。结核菌素试验(TST)敏感性55.17%,特异性72.22%,阳性预测值61.54%,阴性预测值66.67%。三种方法中,T-SPOT.TB的敏感性和阴性预测值最高。T-SPOT.TB和痰找抗酸杆菌、TST试验的敏感性和阴性预测值比较差异均有统计学意义,P0.01。痰找抗酸杆菌特异性和阳性预测值最高,三者比较差异有统计学意义,P0.05。结论：本研究显示T-SPOT. TB检测有较高的敏感性,对临床诊断提供有利的证据。较高的T-SPOT. TB阴性预测值提示阴性结果有助于排除活动性结核病的诊断。尤其在肺外结核诊断中敏感性高,解决了肺外结核诊断难这一难题。但T-SPOT.TB检测存在一定的假阳性,而且费用高,限制了在欠发达地区的推广
[Abstract]:Background: China is a country with high incidence of tuberculosis. Tuberculosis has been one of the most dangerous infectious diseases to human health. The traditional diagnostic techniques of tuberculosis infection such as acid-fast bacillus sputum and TST test have the disadvantages of low sensitivity and poor specificity. In recent years, a new diagnosis method of tuberculosis based on TB antigen-specific T cell reaction, T-SPOT.TB, has been gradually established and developed in clinical practice. However, the clinical application value of this method is still lack of large sample research. Methods and objective: from January 2012 to June 2012, 273 cases of suspected active tuberculosis infection were analyzed retrospectively in Department of Respiratory Medicine and Department of infection, the first affiliated Hospital of Zhejiang University. The results of T-SPOT.TB were compared with the final clinical diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used to evaluate T-SPOT. The value of TB in the diagnosis of active tuberculosis. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of T-SPOT.TB, acid-fast bacillus sputum and TST test were compared. To evaluate the value of T-SPOT.TB, acid-fast bacillus sputum and TST test in the diagnosis of tuberculosis. Results one hundred and seventy-three patients with active tuberculosis were diagnosed in the end. 144 cases were excluded from tuberculosis and 13 cases were still unknown. The T-SPOT.TB results were positive in 101 patients with active tuberculosis, and the sensitivity was 87.07. Of the 144 patients excluded from the diagnosis of active tuberculosis, T-SPOT.TB was negative in 115 patients and the specificity was 79.86. The positive predictive value was 77.69, the negative predictive value was 88.46, the positive likelihood ratio was 4.32, and the negative likelihood ratio was 0.16. Among the patients diagnosed as active tuberculosis, 91 were positive for T-SPOT.TB in pulmonary tuberculosis, and 23 were positive for T-SPOT.TB in 25 patients with extrapulmonary tuberculosis. The sensitivity of 92%.T-SPOT.TB in the diagnosis of extrapulmonary tuberculosis was significantly higher than that of pulmonary tuberculosis. The difference was statistically significant (P0.01). The sensitivity of sputum to acid-fast bacilli was 32.97, the specificity was 99.04, the positive predictive value was 96.77 and the negative predictive value was 62.80. The sensitivity of tuberculin test was 55.17, the specificity was 72.22, the positive predictive value was 61.54, and the negative predictive value was 66.67. The sensitivity and negative predictive value of T-SPOT.TB were the highest. T-SPOT.TB and TST test of acid-fast sputum had significant differences in sensitivity and negative predictive value (P 0.01). The specificity and positive predictive value of acid-fast bacillus in phlegm were the highest, and the difference was statistically significant (P 0.05). Conclusion: this study shows that T-SPOT. TB detection has high sensitivity and provides favorable evidence for clinical diagnosis. Higher T-SPOT. The negative predictive value of TB suggested that the negative results were helpful to exclude the diagnosis of active tuberculosis. Especially in the diagnosis of extrapulmonary tuberculosis high sensitivity, solve the problem of diagnosis of extrapulmonary tuberculosis difficult. However, there are some false positives in T-SPOT.TB test, and the cost is high, which limits the popularization in less developed areas.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R52

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