Chinese Medical Sciences Journal ›› 2019, Vol. 34 ›› Issue (4): 233-240.doi: 10.24920/003497

• 论著 •    下一篇

γ干扰素释放试验对结核性淋巴结炎的诊断价值研究

刘昕超1,#,叶素素1,#,王文泽2,张月秋1,张丽帆1,3,潘晓承4,周子月4,张妙颜4,刘江浩4,梁智勇2,刘晓清1,3,*()   

  1. 1. 北京协和医院感染科
    2. 北京协和医院病理科
    3. 国际临床流行病学网临床流行病学单位
    4. 北京协和医院内科
  • 收稿日期:2018-08-16 接受日期:2019-03-22 出版日期:2019-12-31 发布日期:2019-11-12
  • 通讯作者: 刘昕超,叶素素,刘晓清 E-mail:liuxq@pumch.cn

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis

Xinchao Liu1,#,Susu Ye1,#,Wenze Wang2,Yueqiu Zhang1,Lifan Zhang1,3,Xiaocheng Pan4,Ziyue Zhou4,Miaoyan Zhang4,Jianghao Liu4,Zhiyong Liang2,Xiaoqing Liu1,3,*()   

  1. 1. Department of Infectious Diseases, Peking Union Medical College Hospital
    2. Department of pathology, Peking Union Medical College Hospital
    3. Clinical Epidemiology Unit, International Epidemiology Network
    4. Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2018-08-16 Accepted:2019-03-22 Published:2019-12-31 Online:2019-11-12
  • Contact: Xinchao Liu,Susu Ye,Xiaoqing Liu E-mail:liuxq@pumch.cn

摘要: 目的 评价γ干扰素释放试验T-SPOT.TB对结核性淋巴结炎(tuberculosis Lymphadenitis, TBL)的诊断价值。方法 回顾性收集2010.9至2018.9疑诊TBL并同时具有外周血T-SPOT.TB检测结果和淋巴结活检病理结果的病例。外周血T-SPOT.TB的诊断阈值参照试剂盒标准确定为24 SFC/10 6 PBMC。淋巴结核诊断的金标准为:淋巴结活检组织培养到结核分枝杆菌,或抗酸染色阳性,或组织病理提示淋巴结核且患者经抗结核治疗后临床或影像学好转。评估外周血T-SPOT.TB检测对结核性淋巴结炎的诊断效能,包括灵敏度、特异度、准确度、阳性预测值、阴性预测值及其似然比。 结果 共收集到91例符合纳入标准的病例。排除8例临床资料不全及6例失访者后,共77例纳入研究。参照金标准,结核性淋巴结炎阳性患者37例(确诊结核性淋巴结炎者9例,结核性淋巴结炎可能性大者28例),非结核性淋巴结炎患者30例,另10例临床诊断不确定者在统计分析时予以排除。纳入分析的患者中T-SPOT.TB结果阳性者43例,阴性者24例。外周血T-SPOT.TB诊断结核性淋巴结炎的灵敏度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为89.2%,66.7%,79.1%,76.7%,83.3%,2.68和0.16。结核性淋巴结炎组的T-SPOT.TB斑点形成细胞数为[432 (134-1264)/10 6 PBMCs],非结核性淋巴结炎组为[0(0-30)/10 6 PBMCs],两者之间的差异有显著统计学意义(Z=-5.306,P<0.001)。 结论 T-SPOT.TB可考虑作为诊断结核性淋巴结炎的一种简单、快速、高灵敏度和高阴性预测价值的检测方法。

关键词: 结核性淋巴结炎, 结核感染T细胞斑点检测(T-SPOT.TB), 诊断试验, 灵敏度, 特异度

Abstract: Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/10 6 periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/10 6 PBMCs] was higher than that in non-TBL patients [0 (0-30) /10 6PBMCs] with a significant difference (Z=-5.306, P <0.001).Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.

Key words: Tuberculous lymphadenitis (TBL), T-SPOT.TB, diagnostic test, sensitivity, specificity

基金资助: 国家“十二五”科技重大专项(2014ZX10003003)

Copyright © 2018 Chinese Academy of Medical Sciences. All right reserved.
 
www.cmsj.cams.cn
京公安备110402430088 京ICP备06002729号-1  Powered by Magtech.

Supervised by National Health Commission of the People's Republic of China

9 Dongdan Santiao, Dongcheng district, Beijing, 100730 China

Tel: 86-10-65105897  Fax:86-10-65133074 

E-mail: cmsj@cams.cn  www.cmsj.cams.cn

Copyright © 2018 Chinese Academy of Medical Sciences

All right reserved.

京公安备110402430088  京ICP备06002729号-1