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目的探讨胸水结核感染T细胞斑点试验(T-SPOT.TB)在诊断结核性胸膜炎中的价值。方法收集55例结核性胸膜炎和14例非结核性胸膜炎伴胸腔积液患者的新鲜胸水,分别进行T-SPOT.TB、γ干扰素(IFN-γ)检测和分枝杆菌培养,计算3种方法诊断结核性胸膜炎的敏感度、特异度、阳性预测值、阴性预测值、约登指数和诊断效率。结果 69例患者中,T-SPOT.TB检测阳性51例(73.91%),分枝杆菌培养阳性14例(20.29%),IFN-γ检测阳性43例(62.32%)。T-SPOT.TB检测阳性率高于分枝杆菌培养(P<0.01)。以最终临床确诊结果为标准,T-SPOT.TB、IFN-γ检测和分枝杆菌培养的敏感度分别为89.09%、76.36%和25.45%,特异度分别为85.71%、92.86%和100%,阳性预测值分别为96.08%、97.67%和100%,阴性预测值分别为66.67%、50.00%和25.45%,约登指数分别为0.75、0.69和0.26,诊断效率分别为88.41%、81.16%和40.58%。结论胸水T-SPOT.TB检测对结核性胸膜炎的诊断价值优于IFN-γ检测和分枝杆菌培养法。
Objective To investigate the value of T-SPOT.TB in the diagnosis of tuberculous pleurisy. Methods 55 cases of tuberculous pleurisy and 14 cases of non-tuberculous pleurisy with pleural effusion were collected from fresh pleural fluid. T-SPOT.TB, IFN-γ and Mycobacterium were detected respectively. Three methods were calculated Sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and diagnostic efficiency for diagnosis of tuberculous pleurisy. Results Totally 51 cases (73.91%) were detected by T-SPOT.TB, 14 cases (20.29%) were positive by T-SPOT.TB assay, and 43 cases (62.32%) were positive by IFN-γ test. The positive rate of T-SPOT.TB was higher than that of mycobacteria (P <0.01). The sensitivity and specificity of T-SPOT.TB, IFN-γand mycobacterium culture were 89.09%, 76.36% and 25.45%, respectively, with the specificity of 85.71%, 92.86% and 100% respectively, based on the final clinical diagnosis. The positive predictive value was 96.08%, 97.67% and 100% respectively. The negative predictive values were 66.67%, 50.00% and 25.45% respectively. The Youden index were 0.75, 0.69 and 0.26 respectively. The diagnostic efficiencies were 88.41%, 81.16% and 40.58 %. Conclusion The diagnostic value of pleural effusion T-SPOT.TB in tuberculous pleurisy is better than IFN-γ and mycobacterium culture.