免疫学检测联合痰涂片和痰培养检测在活动性肺结核临床诊断中的价值

doi:10.3969/j.issn.1000-6621.2021.10.017

摘要/Abstract

摘要：

目的分析结核感染T细胞斑点试验(T-SPOT.TB)、结核抗体、痰涂片与痰培养联合检测在活动性肺结核诊断中的临床意义。方法收集2014年1月至2019年12月北京结核病控制研究所门诊收治的疑似活动性肺结核患者715例,最终诊断为活动性肺结核患者412例(肺结核组),非结核病患者303例(非结核组)。715例患者均行T-SPOT.TB检测、结核抗体检测及痰涂片、痰培养检查;以临床诊断结果为标准,分析4种方法单独及联合检测的临床意义。结果肺结核组患者中,T-SPOT.TB阳性检出率为83.7%(345/412);非结核组患者中,T-SPOT.TB阳性检出率为20.8%(63/303);两组阳性检出率差异有统计学意义(χ²=2.823,P=0.000)。T-SPOT.TB对活动性肺结核检测的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为83.7%(345/412)、79.2%(240/303)、84.6%(345/408)、78.2%(240/307)、81.8%[(345+240)/715];4种方法联合诊断的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为93.7%(386/412)、50.8%(154/303)、72.1%(386/535)、85.6%(154/180)、75.5%[(386+154)/715]。T-SPOT.TB检测、结核抗体检测及痰涂片、痰培养检查的ROC曲线下面积(AUC)分别为0.815、0.575、0.593、0.715,四项联合检测的AUC为0.894。结论 T-SPOT.TB检测的敏感度、阴性预测值较好,T-SPOT.TB检测联合结核抗体、痰涂片和痰培养检测的敏感度、AUC较高,联合检测可提高对肺结核的诊断效能。

关键词: 酶联免疫斑点检测, 结核, 肺, 对比研究

Abstract:

Objective To analyze the diagnostic value of combining tuberculosis infection T cell spot test (T-SPOT.TB), tuberculosis antibody,sputum smear and culture tests in detecting active pulmonary tuberculosis. Methods A total of 715 cases with suspected active pulmonary tuberculosis admitted to Beijing Tuberculosis Control Institute from January 2014 to December 2019 were examined, and 412 cases of active pulmonary tuberculosis (TB group) and 303 cases of non-tuberculosis patients (non-TB group) were finally diagnosed. All of them were tested with T-SPOT.TB, tuberculosis antibody, sputum smear and culture tests, to analyze the diagnostic performance of single test and combined tests with those four methods. Results In the TB group, the positive rate of T-SPOT.TB was 83.7% (345/412), while in the non-TB group, it was 20.8% (63/303). The difference was statistically significant (χ²=2.823, P=0.000). The sensitivity, specificity, positive and negative predictive value and accuracy of T-SPOT.TB were 83.7% (345/412), 79.2% (240/303), 84.6% (345/408),78.2% (240/307) and 81.8% ((345+240)/715), respectively, while for combining four methods, they were 93.7% (386/412), 50.8% (154/303), 72.1% (386/535), 85.6% (154/180) and 75.5% ((386+154)/715), respectively. The area under ROC curve (AUC) of T-SPOT.TB, tuberculosis antibody, sputum smear and culture tests were 0.815, 0.575, 0.593 and 0.715, respectively, and the AUC of combining those four tests was 0.894. Conclusion The sensitivity and negative predictive value of T-SPOT.TB test are high, T-SPOT.TB combined with tuberculosis antibody and traditional sputum smear, culture tests has better sensitivity and AUC. Combined tests can improve the efficiency for diagnosing pulmonary tuberculosis.

Key words: Enzyme-linked immunospot assay, Tuberculosis, pulmonary, Comparative study

田丽丽, 杨新宇, 代小伟, 陈双双, 赵琰枫, 王嫩寒, 张洁, 易俊莉, 任怡宣, 陈昊, 樊瑞芳, 石伟先, 武文清, 黄春, 丁北川. 免疫学检测联合痰涂片和痰培养检测在活动性肺结核临床诊断中的价值[J]. 中国防痨杂志, 2021, 43(10): 1073-1078. doi: 10.3969/j.issn.1000-6621.2021.10.017

TIAN Li-li, YANG Xin-yu, DAI Xiao-wei, CHEN Shuang-shuang, ZHAO Yan-feng, WANG Nen-han, ZHANG Jie, YI Jun-li, REN Yi-xuan, CHEN Hao, FAN Rui-fang, SHI Wei-xian, WU Wen-qing, HUANG Chun, DING Bei-chuan. Diagnostic value of immunological test combined with sputum smear and sputum culture in clinical diagnosis of active pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2021, 43(10): 1073-1078. doi: 10.3969/j.issn.1000-6621.2021.10.017

图/表 3

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检测方法		临床诊断(例)				敏感度 (%)		特异度 (%)		阳性预测值 (%)		阴性预测值 (%)		准确度 (%)
检测方法		肺结核 (412例)		非结核 (303例)		敏感度 (%)		特异度 (%)		阳性预测值 (%)		阴性预测值 (%)		准确度 (%)
T-SPOT.TB						83.7		79.2		84.6		78.2		81.8
阳性		345		63
阴性		67		240
结核抗体						44.7		70.3		67.2		48.3		55.5
阳性		184		90
阴性		228		213
痰涂片						19.7		99.0		96.4		47.5		53.3
阳性		81		3
阴性		331		300
痰培养					46.4		96.7		95.0		57.0		67.7
阳性	191		10
阴性	221		293

联合检测方法	临床诊断(例)		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	准确度 (%)
联合检测方法	肺结核 (412例)	非结核 (303例)	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	准确度 (%)
T-SPOT.TB+痰涂片			85.2	78.5	84.4	79.6	82.4
阳性	351	65
阴性	61	238
T-SPOT.TB+痰培养			89.6	76.9	84.1	84.4	84.2
阳性	369	70
阴性	43	233
T-SPOT.TB+结核抗体			90.3	53.1	72.4	80.1	74.5
阳性	372	142
阴性	40	161
痰涂片+结核抗体			55.3	69.6	71.3	53.4	61.4
阳性	228	92
阴性	184	211
痰培养+结核抗体			69.2	67.7	74.4	61.7	68.5
阳性	285	98
阴性	127	205
痰涂片+痰培养			48.3	96.7	95.2	57.9	68.8
阳性	199	10
阴性	213	293
T-SPOT.TB+痰涂片+痰培养			90.0	75.9	83.6	84.9	84.1
阳性	371	73
阴性	41	230
T-SPOT.TB+痰涂片+痰培养+ 结核抗体			93.7	50.8	72.1	85.6	75.5
阳性	386	149
阴性	26	154