摘要
目的:探讨T-SPOT.TB、ADA、TBDNA对结核性胸膜炎的诊断价值。方法:选取本院2016年8月-2019年3月收治的30例结核性胸膜炎患者纳入结核性胸膜炎组,25例癌性胸腔积液、2例肺炎性胸腔积液、2例脓胸纳入非结核性胸膜炎组(共29例);使用ELISPOT试剂盒对胸腔积液进行T-SPOT.TB分析、日立HITACHI7600-110型全自动生化分析仪对胸腔积液进行ADA活性检测、PCR反应检测胸腔积液TBDNA水平。结果:T-SPOT.TB敏感度为80.0%(24/30),特异度为75.9%(22/29),结核性胸膜炎组抗原A孔平均计数(41.54±13.52)个,高于非结核性胸膜炎A孔平均计数(9.21±3.79)个,差异有统计学意义(P<0.05)。ADA敏感度为86.7%(26/30),特异度为79.3%(23/29),ADA均值(54.05±23.04)U/L,高于非结核性胸膜炎均值(13.55±7.66)U/L,差异有统计学意义(P<0.05)。TBDNA阳性比例33.3%(10/30)明显高于非结核性胸膜炎阳性比例10.3%(3/29)(P<0.05),TBDNA诊断的敏感度为33.3%(10/30),特异度为86.7%(26/29)。外周血T-SPOT.TB敏感度、胸腔积液ADA敏感度均高于TBDNA(80.0%、86.7%vs 33.3%)(P<0.05),T-SPOT.TB敏感度与ADA敏感相近(80.8%vs 86.7%)(P>0.05)。TBDNA特异度均高于T-SPOT.TB特异度、ADA特异度(89.7%vs 75.9%、79.3%)(P<0.05);T-SPOT.TB特异度、ADA特异度相近(75.9%vs 79.3%)(P>0.05)。当T-SPOT.TB、ADA、TBDNA3项检测均为阳性,相比于T-SPOT.TB和ADA、T-SPOT.TB和TBDNA、ADA和TBDNA2项检测为阳性,其特异度最高(96.6%vs 89.7%、93.1%、93.1%),但差异无统计学意义(P>0.05)。当T-SPOT.TB、ADA、TBDNA3项检测中任意一项为阳性,相比于T-SPOT.TB和ADA、T-SPOT.TB和TBDNA、ADA和TBDNA2项检测任意一项为阳性,其敏感度最高(96.7%vs 93.3%、76.7%、80.0%),但差异无统计学意义(P>0.05)。结论:T-SPOT.TB、ADA与TBDNA联合检测是敏感度、特异度较高的结核性胸膜炎的诊断方法,其串联使用时,特异度最高,其并联使用时,敏感度度最高。
Objective: To investigate the value of T-SPOT.TB, ADA and TBDNA in the diagnosis of tuberculous pleurisy. Method: From August 2016 to March 2019, 30 patients with tuberculous pleurisy were selected as tuberculous pleurisy group, 25 patients with Cancerous Pleural effusion, 2 patients with pneumonia pleural effusion and 2 patients with leakage fluid were selected as non tuberculous pleurisy group with a total of 29 cases. T-SPOT.TB analysis was performed for pleural effusion with ELISPOT kit, ADA activity test was performed for pleural effusion with Hitachi Hitachi 7600-110 automatic biochemical analyzer, and the level of TBDNA in pleural effusion was detected by PCR. Result: The sensitivity of T-SPOT.TB was 80.0%(24/30), and the specificity was 75.9%(22/29). The average number of a-hole in tuberculous pleurisy group was(41.54±13.52), which was higher than that in non tuberculous pleurisy group(9.21±3.79), and the difference was statistically significant(P<0.05). The sensitivity of ADA was 86.7%(26/30), the specificity was 79.3%(23/29), and the mean value of ADA was(54.05±23.04) U/L, which was higher than that of non tuberculous pleurisy(13.55±7.66) U/L, and the difference was statistically significant(P<0.05). The positive rate of TBDNA was 33.3%(10/30), which was significantly higher than that of non tuberculous pleurisy 10.3%(3/29)(P<0.05). The sensitivity and specificity of TBDNA diagnosis were 33.3%(10/30) and 86.7%(26/49). The sensitivity of T-SPOT.TB in peripheral blood and ADA in pleural effusion were higher than that of TBDNA(80.0%, 86.7% vs 33.3%)(P<0.05). The sensitivity of T-SPOT.TB was similar to that of ADA(80.8% vs 86.7%), and the difference was not statistically significant(P>0.05). The specificity of TBDNA were higher than those of T-SPOT.TB and ADA(89.7% vs 75.9%, 79.3%), and the difference was statistically significant(P<0.05). The specificity T-SPOT.TB and ADA were similar(75.9% vs 79.3%), and the differences were not statistically significant(P>0.05). When T-SPOT.TB, ADA and TBDNA were all positive, compared with T-SPOT.TB and ADA, T-SPOT.TB and TBDNA, ADA and TBDNA, the specificity was the highest(96.6% vs 89.7%, 93.1%, 93.1%), but the difference was not statistically significant(P>0.05). When one of T-SPOT.TB, ADA and TBDNA was positive, compared with T-SPOT.TB and ADA, T-SPOT.TB and TBDNA, ADA and TBDNA, the sensitivity was the highest(96.7% vs 93.3%, 76.7%, 80.0%), but the difference was not statistically significant(P>0.05). Conclusion: The combination of T-SPOT.TB, ADA and TBDNA is the diagnostic methods of tuberculous pleurisy with high sensitivity and specificity. When they are used in series, the specificity is the highest. When they are used in parallel, the sensitivity is the highest.
作者
陈炎城
何丹
曾运泉
CHEN Yancheng;HE Dan;ZENG Yunquan(Meizhou People’s Hospital,Meizhou 514000,China;不详)
出处
《中国医学创新》
CAS
2020年第13期32-36,共5页
Medical Innovation of China
基金
2017年梅州市医药卫生科研立项课题(2017-B-40)。
