中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (8): 846-853.doi: 10.3969/j.issn.1000-6621.2018.08.013
王雅,吴妹英,杨坤云,阿尔泰,吴树才,耿书军,李志惠,李明武,康万里(),唐神结()
收稿日期:
2018-04-17
出版日期:
2018-08-10
发布日期:
2018-09-09
通信作者:
王雅,康万里,唐神结
E-mail:kangwlchch@163.com;tangsj1106@vip.sina.com
Ya WANG,Mei-ying WU,Kun-yun YANG, ,Shu-cai WU,Shu-jun GENG,Zhi-hui LI,Ming-wu LI,Wan-li KANG(),Shen-jie TANG()
Received:
2018-04-17
Online:
2018-08-10
Published:
2018-09-09
Contact:
Ya WANG,Wan-li KANG,Shen-jie TANG
E-mail:kangwlchch@163.com;tangsj1106@vip.sina.com
摘要: 目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)对糖尿病并发肺结核患者的诊断价值。方法 回顾性分析了2012年12月至2015年11月在北京胸科医院、苏州市第五人民医院、湖南省胸科医院、新疆维吾尔自治区胸科医院、河北省胸科医院、昆明市第三人民医院结核科住院的207例糖尿病并发肺结核及95例单纯糖尿病患者临床资料,其中糖尿病并发培养阳性肺结核患者组141例(简称“Ⅰ组”)、糖尿病并发培养阴性肺结核患者组(简称“Ⅱ组”)66例、单纯糖尿病患者组(简称“Ⅲ组”)95例。应用全血T-SPOT.TB 试剂盒检测外周血淋巴细胞对MTB菌株早期分泌性靶抗原6(ESAT-6)和培养滤液蛋白10(CFP-10)的免疫反应。结果 T-SPOT.TB检测在Ⅰ组、Ⅱ组、Ⅲ组患者中的阳性率分别为92.9%(131/141) (95%CI:87.3%~96.5%)、86.4% (57/66)(95%CI:75.7%~93.6%)、48.4% (46/95)(95%CI:38.0%~58.9%)。Ⅰ组的T-SPOT.TB检测阳性率高于Ⅲ组,差异有统计学意义(χ 2=59.91,P<0.01);Ⅱ组的T-SPOT.TB检测阳性率高于Ⅲ组,差异有统计学意义(χ 2=24.33,P<0.01)。Ⅰ组的T-SPOT.TB检测阳性率与Ⅱ组接近,差异无统计学意义(χ 2=2.31,P=0.129)。以肺结核临床诊断为金标准,T-SPOT.TB检测糖尿病并发肺结核的敏感度、特异度、阳性预测值、阴性预测值、诊断准确度分别为90.8%(188/207) (95%CI:86.0%~94.3%)、51.6%(49/95) (95%CI:41.1%~62.0%)、80.3%(188/234) (95%CI:74.7%~85.2%)、72.1%(49/68) (95%CI:59.9%~82.3%)、78.5%(237/302) (95%CI:73.4%~83.0%)。结论 T-SPOT.TB检测糖尿病并发肺结核具有较高的阳性率、敏感度和特异度,可以作为糖尿病并发肺结核的一种辅助诊断方法。
王雅,吴妹英,杨坤云,阿尔泰,吴树才,耿书军,李志惠,李明武,康万里,唐神结. 结核感染T细胞斑点试验在糖尿病并发肺结核诊断中的价值[J]. 中国防痨杂志, 2018, 40(8): 846-853. doi: 10.3969/j.issn.1000-6621.2018.08.013
Ya WANG,Mei-ying WU,Kun-yun YANG, ,Shu-cai WU,Shu-jun GENG,Zhi-hui LI,Ming-wu LI,Wan-li KANG,Shen-jie TANG. The diagnostic value of T cell enzyme-linked immunospot tuberculosis assay in diabetes complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2018, 40(8): 846-853. doi: 10.3969/j.issn.1000-6621.2018.08.013
表1
不同人口学特征在三组患者中的分布情况
人口学特征 | Ⅰ组(141例) | Ⅱ组(66例) | Ⅲ组(95例) | χ2值 | P值 |
---|---|---|---|---|---|
性别 | 3.52 | 0.172 | |||
男[例数(构成比,%)] | 118(83.7) | 48(72.7) | 74(77.9) | ||
女[例数(构成比,%)] | 23(16.3) | 18(27.3) | 21(22.1) | ||
年龄(岁) | 24.39 | <0.01 | |||
中位数 | 52 | 54 | 61 | ||
四分位数(P25,P75) | 44,61 | 45,66 | 55,70 | ||
BMI | 11.07 | 0.004 | |||
中位数 | 21.97 | 22.24 | 23.12 | ||
四分位数(P25,P75) | 20.07,23.69 | 20.02,24.52 | 20.94,25.69 | ||
低白蛋白[例数(比率,%)] | 42(29.8) | 12(18.2) | 26(27.4) | 3.16 | 0.206 |
有TB接触史[例数(比率,%)] | 8(5.7) | 4(6.1) | 5(5.3) | 0.15 | 0.999 |
接种过卡介苗[例数(比率,%)] | 85(60.3) | 24(36.4) | 57(60.0) | 11.70 | 0.003 |
抽烟[例数(比率,%)] | 68(48.2) | 28(42.4) | 37(38.9) | 2.07 | 0.355 |
饮酒[例数(比率,%)] | 55(39.0) | 20(30.3) | 25(26.3) | 4.43 | 0.109 |
表2
不同临床特征在两组糖尿病并发肺结核患者中的分布
临床特征 | Ⅰ组(141例) | Ⅱ组(66例) | χ2值 | P值 |
---|---|---|---|---|
主诉 | ||||
咳嗽 | 131(92.9) | 55(83.3) | 4.52 | 0.033 |
咳痰 | 123(87.2) | 50(75.8) | 4.31 | 0.038 |
发热 | 60(42.6) | 23(34.8) | 1.11 | 0.292 |
咳血 | 26(18.4) | 16(24.2) | 0.94 | 0.333 |
盗汗 | 42(29.8) | 11(16.7) | 4.06 | 0.044 |
体质量减轻 | 44(31.2) | 11(16.7) | 4.87 | 0.027 |
抗酸杆菌阳性 | 129(91.5) | 14(21.2) | 103.96 | <0.01 |
结核病变范围 | 12.58 | <0.01 | ||
≤3个肺野 | 61(43.3) | 46(69.7) | ||
≥4个肺野 | 80(56.7) | 20(30.3) | ||
空洞及其范围 | 10.71 | 0.003 | ||
无空洞 | 58(41.1) | 43(65.2) | ||
≤3个肺野 | 79(56.0) | 23(34.8) | ||
≥4个肺野 | 4(2.9) | 0(0.0) | ||
结核病病程 | 1.06 | 0.302 | ||
<1个月 | 18(12.8) | 12(18.2) | ||
≥1个月 | 123(87.2) | 54(81.8) | ||
患者类型 | 1.46 | 0.226 | ||
初治 | 115(81.6) | 49(74.2) | ||
复治 | 26(18.4) | 17(25.8) |
表3
各类相关因素对糖尿病并发肺结核患者T-SPOT.TB 检测阳性的影响
因素 | 患者例数 (207例) | T-SPOT.TB检测阳性 例数(188例) | 阳性率 (%) | χ2值 | P值 |
---|---|---|---|---|---|
性别 | 1.10 | 0.294 | |||
男 | 166 | 153 | 92.2 | ||
女 | 41 | 35 | 85.4 | ||
年龄(岁) | 0.32 | 0.571 | |||
>65 | 39 | 34 | 87.2 | ||
≤65 | 168 | 154 | 91.7 | ||
BMI | 0.00 | 0.999 | |||
<18.5 | 27 | 25 | 92.6 | ||
≥18.5 | 180 | 163 | 90.6 | ||
白蛋白 | 0.06 | 0.802 | |||
正常 | 153 | 138 | 90.2 | ||
降低 | 54 | 50 | 92.6 | ||
痰培养 | 2.31 | 0.129 | |||
阳性 | 141 | 131 | 92.9 | ||
阴性 | 66 | 57 | 86.4 | ||
痰涂片 | 2.65 | 0.104 | |||
阳性 | 143 | 133 | 93.0 | ||
阴性 | 64 | 55 | 85.9 | ||
病变范围 | 0.32 | 0.570 | |||
≤3个肺野 | 107 | 96 | 89.7 | ||
≥4个肺野 | 100 | 92 | 92.0 | ||
空洞 | 0.37 | 0.541 | |||
有 | 106 | 95 | 89.6 | ||
无 | 101 | 93 | 92.1 | ||
空洞范围 | -a | 0.302 | |||
≤3个肺野 | 203 | 185 | 91.1 | ||
≥4个肺野 | 4 | 3 | 75.0 | ||
结核病病程(月) | 0.03 | 0.862 | |||
<1 | 30 | 28 | 93.3 | ||
≥1 | 177 | 160 | 90.4 | ||
患者类型 | 0.00 | 0.999 | |||
初治 | 164 | 149 | 90.9 | ||
复治 | 43 | 39 | 90.7 | ||
结核病接触史 | 0.00 | 0.999 | |||
有 | 12 | 11 | 91.7 | ||
无 | 195 | 177 | 90.8 | ||
疫苗接种 | 0.24 | 0.628 | |||
有 | 109 | 100 | 91.7 | ||
无 | 98 | 88 | 89.8 | ||
抽烟 | 0.01 | 0.928 | |||
有 | 96 | 87 | 90.6 | ||
无 | 111 | 101 | 91.0 | ||
饮酒 | 0.00 | 0.954 | |||
有 | 75 | 68 | 90.7 | ||
无 | 132 | 120 | 90.9 |
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