结核感染T细胞斑点试验对结核性胸膜炎的诊断价值.pdf

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1、当代医学2015年5月第21卷第15期总第386期ContemporaryMedicine，May．2015，Vo1．21No．15IssueNo．386doi：10．3969／J．issn．1009-4393．2015．15．021结核感染T细胞斑点试验对结核性胸膜炎的诊断价值汪敏张琦张清林[摘要】目的评价结核感染T细胞斑点试验(T-SPOTTB)对诊断结核性胸膜炎的价值。方法前瞻性纳入疑诊结核性胸膜炎患者1O0例，进行外周血T-SPOT．TB、血清结核抗体、胸腔积液腺苷脱氨酶(ADA)检测，并比较外周血T-SPOTTB、胸腔积

2、液ADA、血清结核抗体检测诊断结核性胸膜炎的灵敏度。外周血T-SPOT．TB、胸腔积液ADA、血清结核抗体检测诊断结核性胸膜炎的灵敏度分别为92．6％、95．5％、364％；特异度分别为923％、75％、768％；阳性预测值分别为962％、91．7％、571％，阴性预测值分别为85．7％、857％、355％T—SPOTTB特异度与后两种方法比较，差异均有统计学意义(均p<005)。灵敏度及阳性预测值、阴性预测值与胸水ADA比较，差异均无统计学意义；与血清结核抗体比较，差异均有统计学意义(均P<005)。结论T-SPOTTB对诊断结

3、核性胸膜炎有较高的灵敏度及特异度，对临床应用有重要的参考价值。[关键词】结核感染T细胞斑点试验；结核性胸膜炎；结核抗体；胸水腺苷脱氨酶【Abstract】ObjectiveToevaluatethevalueofT-SPOT．TB(tuberculouspleurisy)inthediagnosisoftuberculouspleurisy．MethodsAtotalof50patientswithclinicallysuspectedTBPadmittedwereenrolledinthisprospectivecohortst

4、udy．PeripheralbloodT-SPOTB．asceticadenosinedeaminase(ADA)andserumtuberculosisantibody{TB．Ab)weremeasuredinthe100patientsandwecomparedthediagnosticvalueofthe3methods．ResultsAccordingtothestandardofdiagnosisofTBPandgrouping．54patientswerediagnosedwithtuberculouspleurisy

5、．ThesensitivityofT．SPOT．TBforthediagnosisoftuberculouspleurisywas92．6％(50／54)．withstatisticalsignificancewhencomparedwithserumTB—Ab36．4％f16／44)

6、tuberculouspleurisywas92．3％f24l／26)，withstatistica1significancewhencomparedwithserumTB-Ab78．6％(22／28)andasciticADA75％(12／16)(尸<0．05)．ThepositivepredictionvalueofT-SPOT．TBforthediagnosisoftuberculouspleurisywas96．2％(50／52)，withstatisticalsignificancewhencomparedwithser

7、umTB—Ab57．1％(8／14)fP<0．05)．andwithoutstatistica1significancewhencomparedwithasciticADA91．7％(44／48)．ThenegativepredictionvalueofT-SPOTBfortheidentificationofnon．tuberculouspleurisywas85．7％(24／28)．withstatisticalsignificancewhencomparedwithserumTB—Ab35．5％(22／621．andasce

8、ticADA85．7％(12／14)fP