比較結(jié)核感染T細胞斑點試驗、結(jié)核菌素試驗以及血清結(jié)核抗體檢測對診斷肺結(jié)核的價值

[摘要] 目的 比較結(jié)核感染T細胞斑點試驗（T-cell spot of tuberculosis，T-SPOT.TB）、結(jié)核菌素試驗（purified protein derivative，PPD）以及血清結(jié)核抗體（Tuberculosis antibody，TB-Ab）檢測對肺結(jié)核的診斷價值。 方法 隨機選取自2014年1月—2016年8月在該院確診為肺結(jié)核患者60例，作為肺結(jié)核組；確診非肺結(jié)核就診者30名作為非肺結(jié)核組，兩組就診者均接受了T-SPOT.TB、PPD以及TB-Ab檢測。比較兩組接受不同檢測方法對診斷肺結(jié)核靈敏性與特異性的差異。結(jié)果 T-SPOT.TB檢測診斷肺結(jié)核的敏感性為73.30%，特異性為80.00%；PPD試驗診斷肺結(jié)核的敏感性為60.00%，特異性為86.70%；血清TB-Ab檢測檢測診斷肺結(jié)核的敏感性為53.30%，特異性為66.70%。結(jié)論 T-SPOT.TB診斷肺結(jié)核的敏感性高于PPD試驗和血清結(jié)核抗體檢測；T細胞斑點試驗T-SPOT.TB診斷肺結(jié)核的特異性高于血清結(jié)核抗體檢測，與PPD試驗差異無統(tǒng)計學意義。

[關(guān)鍵詞] 結(jié)核感染T細胞斑點試驗；PPD試驗；血清結(jié)核抗體；肺結(jié)核

[中圖分類號] R322.3 [文獻標識碼] A [文章編號] 1674-0742（2016）12（b）-0041-03

Comparison of T-SPOT.TB， PPD， and TB-Ab Detection in the Diagnosis of Pulmonary Tuberculosis

HUANG Han-peng

Department of Respirology， Affiliated Hospital of Jiangsu University， Zhenjiang， Jiangsu Province，212001 China

[Abstract] Objective To compare of T-cell spot of tuberculosis（T-SPOT.TB）， purified protein derivative test（PPD）， and serum tuberculosis antibody detection（TB-Ab） in the diagnosis of pulmonary tuberculosis. Methods 90 patients from January 2014 to August 2016 in our hospital were random selected and divided into pulmonary tuberculosis group（n=60） and non-tuberculosis group（n=30）. The positive rates of T-SPOT.TB， PPD， and TB-Ab in two groups were detected and their sensitivities and specifities were compared. Results The sensitivity of T-SPOT.TB in the diagnosis of pulmonary tuberculosis was 73.30%， and the specificity was 80.00%； The sensitivity of PPD test in the diagnosis of pulmonary tuberculosis was 60.00%， and the specificity was 86.70%； The sensitivity of TB-Ab detection in the diagnosis of pulmonary tuberculosis was 53.30% and specificity was 66.70%. Conclusion The sensitivity of T-SPOT.TB in the diagnosis of tuberculosis is higher than that of PPD test and TB-Ab detection； the specificity of T-SPOT.TB in diagnosis of pulmonary tuberculosis is higher than that of serum TB-Ab detection， and is no significant difference with PPD test.

[Key words] T-cell spot of tuberculosis；Purified protein derivative test； Tuberculosis antibody；Pulmonary tuberculosis

結(jié)核病是單一致病菌致死最多的疾病。隨著社會人口流動性增大、耐藥結(jié)核桿菌株增多以及結(jié)核合并免疫缺陷疾病的增多，我國結(jié)核病的發(fā)病率、患病率呈現(xiàn)逐年增長趨勢，同時肺結(jié)核起病隱匿、臨床表現(xiàn)不典型等特點，造成診斷率低，誤診率、病死率高等現(xiàn)狀[1]。因此提高臨床肺結(jié)核的診斷率尤為重要。目前臨床開展診斷肺結(jié)核項目包括痰結(jié)核菌培養(yǎng)、痰涂片找結(jié)核桿菌、支氣管鏡刷檢找抗酸桿菌、支氣管鏡活檢病理、肺泡灌洗找抗酸桿菌等。此外，還包括血結(jié)核抗體檢測、結(jié)核感染T細胞斑點試驗和結(jié)核菌素試驗等輔助檢查[2-3]。由于我國痰培養(yǎng)陰性肺結(jié)核患者比例較高，約占總肺結(jié)核患者60%～70%，痰涂片陰性肺結(jié)核比例更高?！?br>