外周血结核杆菌感染T细胞斑点试验联合胸腔积液腺苷脱氨酶检测对结核性胸膜炎患者的诊断价值及评价

摘要

ObjectiveTo evaluate the diagnostic value of peripheral blood T-SPOT. TB and pleural effusion’s adenosine deaminase(ADA) in patients with tuberculous pleurisy.MethodPeripheral blood and pleural effusion were collected from 85 cases of tuberculous pleurisy (case group) and 91 cases of non-tuberculous pleurisy (control group) respectively. All the diagnoses were made by medical thoracoscopy and pathology. Peripheral blood T-SPOT.TB and pleural effusion ADA were measured and the best diagnostic threshold were determined by ROC curve.ResultThe sensitivity of peripheral blood T-SPOT. TB for diagnosis of tuberculous pleurisy was 87.06%, the specificity was 70.33%. The cut-off value of ADA was 27U/L in tuberculous pleurisy diagnosis, while its sensitivity and specificity were 89.41% and 95.60% respectively. The sensitivity and specificity of the combined detection of T-SPOT. TB and ADA was 98.63% and 98.69%respectively.ConclusionBoth of peripheral blood T-SPOT.TB and pleural effusion ADA test had high diagnostic value in tuberculous pleurisy. ADA test was more sensitive and specific than T-SPOT. TB test. The combined detection of peripheral blood T-SPOT. TB and pleural effusion ADA has a higher sensitivity and specificity in diagnosis of tuberculous pleurisy.%目的：探讨γ-干扰素释放的T细胞斑点试验（mycobacterium tuberculosis T cell enzyme-linked immunospot tuberculous test，T-SPOT.TB）以及胸腔积液腺苷脱氨酶（adenosine deaminase，ADA）对结核性胸膜炎的诊断价值。方法选取首都医科大学附属北京朝阳医院2012年6月至2014年12月经可弯曲电子内科胸腔镜取胸膜组织病理确诊结核性胸膜炎患者85例（结核组），非结核性胸膜炎患者91例（对照组），分别检测其外周血T-SPOT.TB和胸腔积液ADA活性数值，比较两种方法的特异度、敏感度，并绘制受试者工作特征曲线（ROC曲线），计算最佳临界值。结果外周血T-SPOT.TB检测诊断结核性胸膜炎的敏感度、特异度分别为87.06%和70.33%；胸腔积液ADA活性诊断的敏感度、特异度分别为89.41%和95.60%，其最佳临界值为27U/L；两者ROC曲线下面积分别为0.823和0.966；联合两种检测方法，敏感度和特异度显著升高（P＜0.05），分别为98.63%和98.69%。结论外周血T-SPOT.TB检测和胸腔积液ADA均可作为较好的诊断结核性胸膜炎的指标，胸腔积液ADA比外周血T-SPOT.TB检测更为敏感和特异；若联合两种检测方法，其诊断效能显著提高。