Diagnostic value of immunological test combined with sputum smear and sputum culture in clinical diagnosis of active pulmonary tuberculosis

doi:10.3969/j.issn.1000-6621.2021.10.017

Abstract

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

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

Figures/Tables 3

References 23

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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