联合检测结素试验和血清抗结核抗体对成人肺结核诊断预测价值:Bayesian分析

摘要/Abstract

摘要： 目的　探讨结素试验及血清抗结核抗体对成人肺结核诊断的预测价值。方法经细菌学、病理组织学或细胞学确诊的 134例肺结核病、109例胸部肿瘤及 51例肺部感染成人患者接受结素试验及血清抗结核抗体检查。比较结素试验不同硬结直径作阳性筛查标准及与血清抗结核抗体的不同组合对结核病诊断的价值。阳性预测价值和阴性预测价值的估计应用Bayes公式。结果结素试验与血清抗结核抗体检测,两者结合可提高诊断价值,若以结素试验硬结直径≥15mm或血清抗结核抗体阳性作为阳性筛查标准 (标准 1),则阴性预测价值最大 ;若以结素试验硬结直径≥20mm及血清抗结核抗体阳性作为阳性筛查标准 (标准 2),则阳性预测价值最大。若就诊患者中肺结核患病率分别为:0.5 %,5 %,10 %,30 %,60 %时,标准 1的阴性预测价值分别为:0.999,0.987,0.972,0.901,0.723;标准 2的阳性预测价值均为 1.000。结论在结核高感染地区,联合检测结素试验及血清抗结核抗体对诊断成人结核病仍有辅助价值。结素试验硬结直径小于 15mm且血清抗结核抗体阴性对排除结核病有帮助；结素试验硬结直径≥ 20mm且血清抗结核抗体阳性,对确诊结核病有帮助。

关键词: 结核,肺/诊断, 结核菌素试验, 抗体,细菌

Abstract: Objective To evaluate the predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection for diagnosis of adult pulmonary tuberculosis.Methods Two hundred and ninety-four bacteriologically,patholgic histologically or cytologically proved adult patients received tuberculin skin test and detection of serum IgG antibody to a recombinant 38-kDa antigen from Mycobacterium tuberculosis,134 with TB,109 with chest tumors and 51 with pulmonary infections.The eligible non-TB patients were excluded those complicated with TB.The tuberculin test and the serum anti-Mycobacterium tuberculosis antibody detection were combined to form different positive results.To compare the diagnostic value of different combinations.The predictive value of a positive test and the predictive value of a negative test were estimated by Bayes’s formula.Results The sensitivity of tuberculin test was higher than that of serum anti-Mycobacterium tuberculosis antibody detection.Whereas,the specificity of serum anti-Mycobacterium tuberculosis antibody detection was higher than that of tuberculin test.It can improve the diagnostic value while combined the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection.If a positive result was defined as the diameter of PPD skin test ≥15mm or a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria one),the predictive value of a negative test was the highest.If a positive result was defined as the diameter of PPD skin test≥20mm and a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria two),the predictive value of a positive test was the highest.When the prevalence of tuberculosis was 0.5%,5%,10%,30%,60% respectively.The predictive value of a negative test for criteria one was 0.999,0.987,0.972,0.901,0.723 respectively.And the predictive value of a positive test for criteria two was 1.000.Conclusion In regions with a high prevalence of TB,combination the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection might still be useful for diagnosis of adult TB.It might exclude TB if one’s diameter of PPD skin test＜15mm and a negative of the serum anti-Mycobacterium tuberculosis antibody.It might be TB if one’s diameter of PPD skin test≥20 mm and a positive of the serum anti-Mycobacterium tuberculosis antibody.

Key words: Pulmonary tuberculosis/diagnosis, Tuberculin test, Antibodies bacterial

李德宪,吕江清,邝浩斌,陈志宏,何刚,. 联合检测结素试验和血清抗结核抗体对成人肺结核诊断预测价值:Bayesian分析[J]. 中国防痨杂志, 2005, 27(1): 8-12.

Li Dexian,Lv Jiangqing,Kuang Haobing,et al.. The predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection in diagnosis of adult pulmonary tuberculosis:a Bayesian analysis[J]. Chinese Journal of Antituberculosis, 2005, 27(1): 8-12.

[1]	李婷, 何金戈, 苏茜, 李京, 李运葵, 高文凤, 高媛, 杨文. 结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值[J]. 中国防痨杂志, 2020, 42(9): 931-936.
[2]	李春, 郑海伦, 罗萍, 李亚敏, 赵淑娟, 郭金红, 张丽, 徐静, 屠霞. 2010—2019年北京市大兴区某中学高中部青海藏族集体来京学生肺结核疫情处置分析[J]. 中国防痨杂志, 2020, 42(12): 1318-1322.
[3]	房宏霞,章光荣,秦玉宝,解志民,赖铿,黄成章,王艳,何文龙,郑开巧,肖之凯,刘昌伟,梁健平,陈智聪. 封闭社区结核病患者接触者结核感染状况预测模型[J]. 中国防痨杂志, 2019, 41(9): 936-945.
[4]	房宏霞,解志民,秦玉宝,罗志理,赖铿,余秀齐,王艳,郑开巧,刘昌伟,陈智聪. 监测封闭社区结核病患者接触者结核感染状况二年的结果分析[J]. 中国防痨杂志, 2019, 41(8): 887-891.
[5]	都伟欣,赵爱华,王国治,卢锦标. 结核菌素类产品的发展历程概述[J]. 中国防痨杂志, 2019, 41(10): 1080-1083.
[6]	何秀云黄香玉朱传智陈红兵张翠英肖漓高钰孔祥瑞. PstS1-ESAT-6抗原血清学和γ-干扰素释放试验辅助诊断结核病的价值[J]. 中国防痨杂志, 2016, 38(10): 805-812.
[7]	王永红. 对《2008-2014年中国石油大学(北京)新生PPD试验结果与结核发病情况分析》一文的商榷意见的答复[J]. 中国防痨杂志, 2015, 37(9): 1001-1002.
[8]	孟炜丽，罗萍，胡京坤，孙钊，李慧颖，连赫宇. BCG-PPD与TB-PPD皮肤试验在大学生结核病筛查中的差异性分析[J]. 中国防痨杂志, 2014, 36(7): 542-546.
[9]	江渊，王曲直，张阳奕，沈素芳，李静，唐文红，桂晓虹，梅建，潘启超，沈鑫. 快速检测技术在奶牛结核病检测中的应用研究[J]. 中国防痨杂志, 2014, 36(6): 447-452.
[10]	葛燕萍，肖和平. γ干扰素释放试验与结核菌素皮肤试验辅助检测肺外结核病的比较[J]. 中国防痨杂志, 2014, 36(3): 194-197.
[11]	耿梦杰，宋渝丹，熊勇超，赵飞，胡冬梅，李萌，侯月云，成君，何广学. 结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析[J]. 中国防痨杂志, 2014, 36(2): 121-125.
[12]	路希维. 学校结核病暴发控制策略研究进展[J]. 中国防痨杂志, 2013, 35(9): 752-756.
[13]	陈曦王丽. 2009—2012年中央财经大学入学新生PPD试验结果分析[J]. 中国防痨杂志, 2013, 35(11): 887-890.
[14]	曾谊冯枭宋梅梅林云霞费贤树袁广琴. 酶联免疫斑点试验在菌阴肺结核诊断中的价值[J]. 中国防痨杂志, 2012, 34(2): 100-102.
[15]	陈淑林孙德全石俊峰张爱红夏建华. 高中生PPD反应程度与结核病发病危险的队列研究[J]. 中国防痨杂志, 2012, 34(12): 799-802.

联合检测结素试验和血清抗结核抗体对成人肺结核诊断预测价值:Bayesian分析

The predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection in diagnosis of adult pulmonary tuberculosis:a Bayesian analysis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

友情链接