目的 分析并探讨T细胞斑点技术诊断结核性胸膜炎的临床价值。方法 将2014年5月—2016年5月收治61例的结核性胸膜炎的患者和61例非结核性胸膜炎的患者同时行外周血和胸水的T细胞斑点实验,对各组数据进行统计学处理与分析。结果 结核组血T-SPOT的阳性率为88.52%,高于非结核组的16.39%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为88.52％、83.61%、85.71%、86.44%、5.40、0.14、0.72。结核组胸水T-SPOT的阳性率为90.16%,高于非结核组的8.20%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82。联合外周血及胸水T-SPOT检测阳性率为91.80%,特异度为93.44%,阳性似然比为14.00,阴性似然比为0.09,youden指数为:0.85。结论 T细胞斑点实验检测对结核性胸膜炎有较高的临床诊断价值,外周血及胸水T-SPOT联合检测可提高诊断率,可作为结核性胸膜炎快速早期诊断的有效辅助手段。

Objective To analysis the value of T-SPOT.TB in the diagnosis of tuberculous pleurisy. Methods A total of 61 patients with clinically suspected tuberculous pleurisy (group A) and 61 cases of other diseases caused by pleural effusion (group B)admitted from May 2014 to May 2015 from the Guangzhou Chest Hospital had peripheral blood T-SPOT.TB and pleural effusion T-SPOT.TB,for each group of data for statistical processing and analysis. Results The positive rate of T-SPOT in the blood of the group A was 88.52%, which was higher than group B, (P<0.001) (16.39.0%). And the sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 88.52%, 83.61%,85.714%, 86.44%, 540, 0.14, 0.72 respectively by peripheral blood T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of pleural effusion T-SPOT in the group A was 90.16%, which was also higher than group B (P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82 respectively by pleural effusion T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of the joint tests of T-SPOT in peripheral blood and in peripheral blood was 91.80%, the specificity was 93.44%, the positive likelihood ratio was 14, the negative likelihood ratio was 0.09, and the youden index was 0.85. Conclusion T-SPOT.TB for the diagnosis of tuberculous pleurisy has a higher clinical value in the diagnosis. The joint tests of T-SPOT in peripheral blood and in pleural effusion may improve the positive rate in the diagnosis of tuberculous pleurisy. The joint tests of T-SPOT in peripheral blood and in pleural effusion have an important reference for diagnosing suspected tuberculous pleurisy quickly, early and accurately.