[1]施瑞洁,刘文康,范 云,等.T-SPOT.TB在肺结核早期诊断中的应用研究[J].现代检验医学杂志,2017,32(02):60-63.[doi:10.3969/j.issn.1671-7414.2017.02.016]
　SHI Rui-jie,LIU Wen-kang,FAN Yun,et al.Application of T-SPOT.TB in the Early Diagnosis of Tuberculosis[J].Journal of Modern Laboratory Medicine,2017,32(02):60-63.[doi:10.3969/j.issn.1671-7414.2017.02.016]
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T-SPOT.TB在肺结核早期诊断中的应用研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第32卷
期数:
2017年02期
页码:
60-63
栏目:
论著
出版日期:
2017-03-25

文章信息/Info

Title:
Application of T-SPOT.TB in the Early Diagnosis of Tuberculosis
文章编号:
1671-7414(2017)02-060-04
作者:
施瑞洁1; 刘文康1; 范 云1; 李 博1; 刘 榕1; 王俊艳2; 李 玲1; 闫福堂1
1.陕西省人民医院检验科,西安 710068;
2.第四军医大学唐都医院,西安 710038
Author(s):
SHI Rui-jie1; LIU Wen-kang1; FAN Yun1; LI Bo1; LIU Rong1; WANG Jun-yan2;  LI Ling1; YAN Fu-tang1
1.Department of Clinical Laboratory,Shaanxi Provincial People's Hospital,Xi'an 710068,China;
2.the Tangdu Hospital of Fourth Military Medical University,Xi'an 710038,China
关键词:
肺结核;  荧光定量PCR;  酶联免疫斑点试验;  结核蛋白芯片;  结核菌素试验
分类号:
R521; Q503
DOI:
10.3969/j.issn.1671-7414.2017.02.016
文献标志码:
A
摘要:
目的 探讨结核感染T淋巴细胞酶联免疫斑点试验(tuberculosis T lymphocytes enzyme-linked immune SPOT test,T-SPOT.TB)在肺结核早期诊断中的应用价值。方法 采用T-SPOT.TB,荧光定量PCR(fluorescence quantitative PCR,RQ-PCR)、结核蛋白芯片(TB-Ab protein chip)及结核菌素试验(purified protein derivative,PPD)检测189例疑似肺结核患者是否有结核菌感染。结果 T-SPOT,PCR,TB-AB和PPD方法的敏感度分别为 91.54%(119/130),73.85%(96/130),63.08%(82/130)及57.69%(75/130),特异度分别为89.83%(53/59),86.44%(51/59),67.79%(40/59)及66.10%(39/59); T-SPOT.TB方法敏感度均高于荧光定量PCR法等三种方法(χ2=14.216～41.573,均P<0.05),T-SPOT.TB方法特异度均高于PPD试验及结核蛋白芯片方法(χ2=8.577～9.669,P<0.05); T-SPOT.TB,荧光定量PCR,TB-Ab及 PPD阳性预测值分别为95.2%(119/125),92.3%(96/104),81.2%(82/101)和78.9%(75/95),而阴性预测值分别为82.8%(53/64),60%(51/85),45.5%(40/88)和41.5%(39/94); 四种检测方法的假阳性率(误诊率)分别为10.2%(6/59),13.6%(8/59),32.2%(19/59)和33.9%(20/59),而假阴性率(漏诊率)分别为8.5%(11/130),26.2%(34/130),36.9%(48/130)和42.3%(55/130); 四种检测方法的阴性似然比分别为0.11,0.16,0.48和0.51,而阳性似然比分别为9.0,5.4,2.0和1.7; 四种检测方法的诊断符合率分别为91.0%(172/189),77.8%(147/189),64.6%(122/189)和60.3%(114/189); T-SPOT.TB,荧光定量PCR,TB-Ab及PPD的约登指数分别为0.81,0.60,0.31和0.24。结论 在实验室检测早期结核菌感染的方法中T-SPOT.TB检测法是较敏感且特异度较高的方法,对不同阶段肺结核诊断更具临床应用价值。
Abstract:
Objective This study aims to explore the application value of tuberculosis T lymphocytes enzyme-linked immune SPOT test(T-SPOT.TB)on early diagnosis of tuberculosis.Methods The TB infection in 189 inpatients suspected tuberculosis in pneumology department ofShaanxi Provincial People's Hospital was detected with T-SPOT.TB,fluorescence RQ-PCR,tuberculosis(TB-Ab)protein chip and PPD methods.Results The sensitivity of four methods was 91.54%(119/130),73.85%(96/130),63.08%(82/130)and 57.69%(75/130)respectively and the specificity of those was 89.83%(53/59),86.44%(51/59),67.79%(40/59)and 66.10%(39/59),respectively.The sensitivity of T-SPOT.TB method was statistically higher than those of other three tests,respectively(P<0.05).The specificity of T-SPOT.TB was significantly higher than those of TB-AB and PPD(P<0.05),but there was no statistical difference between RQ-PCR and T-SPOT.TB (P>0.05).The positive predictive values of T-SPOT.TB,fluorescent quantitative PCR,TB-Ab and PPD assays were 95.2%(119/1250),92.3%(96/104),81.2%(82/101)and 78.9%(75/95)respectively while the negative predictive values of those were 82.8%(53/64),60%(51/85),45.5%(40/88)and 41.5%(39/94),respectively.The false-positive rates(misdiagnosis rate)of four assays were 10.2%(6/59),13.6%(8/59),32.2%(19/59)and 33.9%(20/59)respectively and the false-negative rates(rates of missed diagnosis)of those were 8.5%(11/130),26.2%(34/130),36.9%(48/130)and 42.3%(55/130),respectively.The negative likelihood ratios of T-SPOT.TB,fluorescent quantitative PCR,TB-Ab and PPD assayswere 0.11,0.16,0.48 and 0.51 respectively,meanwhile the positive likelihood ratios of T-SPOT.TB,fluorescent quantitative PCR,TB-Ab and PPD assays were 9.0,5.4,2.0 and 1.7,respectively.What's more,the diagnostic accordance rates of the four assays were 91.0%(172/189),77.8%(147/189),64.6%(122/189)and 60.3%(114/189),respectively.Conclusion T-SPOT.TB test is a more sensitive and specific method and of great significance to the early diagnosis of TB,which has more clinical value in different stages of tuberculosis diagnosis.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金资助项目(NO.81272856)。
作者简介:施瑞洁(1971-),女,汉族,本科,主管检验技师,研究方向免疫学检验技术,Tel:13772029196。
通讯作者:李 玲(1964-),女,硕究生,主任检验技师,研究方向免疫学检验技术,Tel:13193368899。
更新日期/Last Update: 2017-04-10