T-SPOT.TB诊断肺外结核病的应用价值研究
发布时间：2018-10-07 19:36
【摘要】：目的:评价T-SPOT.TB在肺外结核病诊断中的应用价值。方法:回顾性纳入2013年1月~2015年12月中国人民解放军第309医院病理科应用PCR反向斑点杂交法进行分枝杆菌菌种鉴定(以下简称分子病理)肺外组织标本280例,病案检索其外周血T-SPOT.TB检测结果,将检测结果与分子病理诊断结果进行比较,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。结果:以分子病理诊断与T-SPOT.TB比较,280例患者中T-SPOT.TB阳性170例,阴性110例;分子病理MCH阳性者1例,MGO阳性5例,MTC阳性共146例,结果阴性128例;分子病理阳性且T-SPOT.TB阳性共148例,分子病理阴性且T-SPOT.TB阳性共22例,分子病理阳性且T-SPOT.TB阴性共4例,分子病理阴性且T-SPOT.TB阴性共106例。敏感性为97.4%(148/152),特异性为82.8%(106/128),阳性预测值为87.0%(148/170),阴性预测值为96.4%(106/110),阳性似然比为5.69,阴性似然比为0.0318。其中骨关节脊柱分子病理例数较多,占54.64%(153/280)敏感度80.0%(60/75),特异度100.0%(78/78),阳性预测值100.0%(60/60),阴性预测值83.9%(78/93);以临床诊断与T-SPOT.TB比较,280例患者中T-SPOT.TB阳性170例,T-SPOT.TB阴性110例,临床诊断结果阳性192例,临床诊断结果阴性88例。临床诊断阳性且T-SPOT.TB阳性145例,临床诊断阴性且T-SPOT.TB阳性25例,临床诊断阳性且T-SPOT.TB阴性47例,临床诊断阴性且T-SPOT.TB阴性63例。敏感性为75.5%(145/192),特异性为42.7%(63/88),阳性预测值为85.3%(145/170),阴性预测值为57.3%(63/110),阳性似然比为2.66,阴性似然比为0.342。结论:本研究显示T-SPOT.TB检测对肺外结核诊断具有较高的敏感性,可对临床诊断提供有利的依据。较高的T-SPOT.TB阴性预测值提示对于排除肺外结核病有重要意义。
[Abstract]:Objective: to evaluate the value of T-SPOT.TB in the diagnosis of extrapulmonary tuberculosis. Methods: from January 2013 to December 2015, 280 specimens of extrapulmonary tissues from the Department of Pathology of the 309th Hospital of the Chinese people's Liberation Army (PLA) were identified by PCR reverse dot blot hybridization. The results of T-SPOT.TB in peripheral blood were searched and compared with the results of molecular pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used as the evaluation indexes. Results: compared with T-SPOT.TB by molecular pathology, 170 cases were positive for T-SPOT.TB, 110 cases were negative, 1 case was positive for MCH, 1 case was positive for MCH, and 128 cases were negative for T-SPOT.TB, 148 cases were positive in molecular pathology and T-SPOT.TB. There were 22 cases with positive molecular pathology and T-SPOT.TB positive, 4 cases with positive molecular pathology and negative T-SPOT.TB, 106 cases with negative molecular pathology and negative T-SPOT.TB. The sensitivity was 97.4% (148 / 152), the specificity was 82.8% (106 / 128), the positive predictive value was 87.0% (148170), the negative predictive value was 96.4% (106 / 110), the positive likelihood ratio was 5.69, the negative likelihood ratio was 0.0318. Among them, 54.64% (153 / 280) had 80.0% (60 / 75) sensitivity, 100.0% (78 / 78) specificity, 100.0% (60 / 60) positive predictive value and 83.9% (78 / 93) negative predictive value. The clinical diagnosis was negative in 88 cases. There were 145 cases with positive clinical diagnosis and T-SPOT.TB positive, 25 cases with negative clinical diagnosis and T-SPOT.TB positive, 47 cases with positive clinical diagnosis and T-SPOT.TB negative, 63 cases with negative clinical diagnosis and T-SPOT.TB negative. The sensitivity was 75.5% (145 / 192), the specificity was 42.7% (63 / 88), the positive predictive value was 85.3% (145 / 170), the negative predictive value was 57.3% (63 / 110), the positive likelihood ratio was 2.66, the negative likelihood ratio was 0.342. Conclusion: this study shows that T-SPOT.TB has a high sensitivity in the diagnosis of extrapulmonary tuberculosis and can provide a favorable basis for clinical diagnosis. The higher T-SPOT.TB negative predictive value suggests that it is important to exclude extrapulmonary tuberculosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52
本文编号：2255422
[Abstract]:Objective: to evaluate the value of T-SPOT.TB in the diagnosis of extrapulmonary tuberculosis. Methods: from January 2013 to December 2015, 280 specimens of extrapulmonary tissues from the Department of Pathology of the 309th Hospital of the Chinese people's Liberation Army (PLA) were identified by PCR reverse dot blot hybridization. The results of T-SPOT.TB in peripheral blood were searched and compared with the results of molecular pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used as the evaluation indexes. Results: compared with T-SPOT.TB by molecular pathology, 170 cases were positive for T-SPOT.TB, 110 cases were negative, 1 case was positive for MCH, 1 case was positive for MCH, and 128 cases were negative for T-SPOT.TB, 148 cases were positive in molecular pathology and T-SPOT.TB. There were 22 cases with positive molecular pathology and T-SPOT.TB positive, 4 cases with positive molecular pathology and negative T-SPOT.TB, 106 cases with negative molecular pathology and negative T-SPOT.TB. The sensitivity was 97.4% (148 / 152), the specificity was 82.8% (106 / 128), the positive predictive value was 87.0% (148170), the negative predictive value was 96.4% (106 / 110), the positive likelihood ratio was 5.69, the negative likelihood ratio was 0.0318. Among them, 54.64% (153 / 280) had 80.0% (60 / 75) sensitivity, 100.0% (78 / 78) specificity, 100.0% (60 / 60) positive predictive value and 83.9% (78 / 93) negative predictive value. The clinical diagnosis was negative in 88 cases. There were 145 cases with positive clinical diagnosis and T-SPOT.TB positive, 25 cases with negative clinical diagnosis and T-SPOT.TB positive, 47 cases with positive clinical diagnosis and T-SPOT.TB negative, 63 cases with negative clinical diagnosis and T-SPOT.TB negative. The sensitivity was 75.5% (145 / 192), the specificity was 42.7% (63 / 88), the positive predictive value was 85.3% (145 / 170), the negative predictive value was 57.3% (63 / 110), the positive likelihood ratio was 2.66, the negative likelihood ratio was 0.342. Conclusion: this study shows that T-SPOT.TB has a high sensitivity in the diagnosis of extrapulmonary tuberculosis and can provide a favorable basis for clinical diagnosis. The higher T-SPOT.TB negative predictive value suggests that it is important to exclude extrapulmonary tuberculosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52
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