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  本文關鍵詞： 結核分枝桿菌 結核分枝桿菌T細胞檢測 活動性結核 ROC曲線　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景和目的WHO 2015年全球結核病報告中提出全球結核病發(fā)病率自2000年來下降了18%,平均每年下降1.5%。死亡率自1990年以來下降了47%。盡管取得了巨大成就,結核病在全球范圍仍然是最嚴重的公共衛(wèi)生威脅。2014年結核病在全球范圍死亡人數(shù)為150萬,近960萬新發(fā)病例我國。我國是世界上結核病發(fā)病率最高的國家之一,僅次于印度,排名第二。其診斷困難,治療時間長,嚴重影響著人們的日常生活。以前結核病的診斷往往依靠于PPD試驗,但是其有許多局限性,近年來,新型的診斷結核菌感染的手段——結核分枝桿菌T細胞檢測(T-SPOT.TB),為MTB感染的診斷帶來的新的方法,本研究即探討T-SPOT.TB對活動性結核的診斷意義。研究方法回顧性分析2015年6月-2016月6日在河南省人民醫(yī)院呼吸科住院期間疑似活動性結核病的病人,總共450例。收集其一般情況資料,并根據(jù)診斷將患者分為活動性結核病組、陳舊性結核病組和非結核病組,評價T-SPOT.TB的靈敏度、特異度、陰性預測值、陽性預測值、陽性似然比、陰性似然比及約登指數(shù)(Youden′s Index)。繪制其診斷的ROC曲線,探索最優(yōu)的診斷界值。比較T-SPOT.TB的A抗原和B抗原數(shù)值在各組間是否存在的差異。研究結果診斷活動性肺結核的靈敏度89.39%,特異度為63.03%,陽性預測值0.55,陰性預測值0.92,陽性似然比2.42,陰性似然比0.17,約登指數(shù)(Youden′s Index)0.52。在T-SPOT.TB診斷活動性結核的ROC曲線中,A抗原的曲線下面積(0.89)大于B抗原(0.86),在A抗原取值為13.5 SFCs/2.5*105PBMC時,診斷價值最優(yōu),約登指數(shù)(Youden′s Index)為0.71,靈敏度為84.10%,特異度為86.50%。T-SPOT.TB在診斷陳舊性肺結核的ROC曲線中,A抗原和B抗原的曲線下面積為0.60、0.58,診斷價值差。其中A抗原、B抗原數(shù)值在活動性結核病組分別與非結核病組、陳舊性肺結核組組間有統(tǒng)計學差異(A抗原χ2=105.41、P㩳0.01,B抗原χ2=91.03、P㩳0.01;A抗原χ2=12.99、P㩳0.01,B抗原χ2=8.56、P㩳0.01),在非結核病組與陳舊性肺結核組間無統(tǒng)計學差異(A抗原χ2=1.07、P㧐0.05,B抗原χ2=0.77、P㧐0.05)。既往卡介苗接種史對假陽性的發(fā)生沒有統(tǒng)計學意義(P㩳0.05),年齡"g65歲、免疫力下降或低下、體重指數(shù)(BMI)㩳16.0 kg/m2這些因素與假陰性的發(fā)生有統(tǒng)計學意義(P㩳0.05)。結論T-SPOT.TB對活動性結核的診斷具有較高的靈敏度和特異度,能為活動性結核的診斷提供重要參考價值,不受既往結核病史和接種卡介苗的影響。
[Abstract]:Background and objective the WHO Global TB report of 2015 states that the global incidence of tuberculosis has dropped by 18 per cent since 2000, with an average annual decline of 1.5 per year. The mortality rate has fallen by 47 per cent since 1990. Tuberculosis is still the most serious public health threat in the world. In 2014, the death toll of tuberculosis in the world was 1.5 million, nearly 9.6 million new cases in China. China is one of the countries with the highest incidence of tuberculosis in the world, second only to India. Second place. Its diagnosis is difficult, the treatment time is long, seriously affects people's daily life. In the past, the diagnosis of tuberculosis often depended on PPD test, but it has many limitations, in recent years, A new method for the diagnosis of tuberculous infection-Mycobacterium tuberculosis T cell detection of T-SPOT.TBX, which brings a new method for the diagnosis of MTB infection. The purpose of this study was to investigate the diagnostic significance of T-SPOT.TB in active tuberculosis. Methods A retrospective analysis was made on the patients suspected of active tuberculosis during their stay in the Department of Respiratory Medicine of Henan Provincial people's Hospital from June 2015 to 6th. The patients were divided into active tuberculosis group, old tuberculosis group and non-tuberculosis group according to the diagnosis. The sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio of T-SPOT.TB were evaluated. The negative likelihood ratio and the Jorden index were used to draw the ROC curve for the diagnosis. To explore the best diagnostic boundary value. To compare the difference between T-SPOT.TB A antigen and B antigen value in each group. The sensitivity of diagnosis of active pulmonary tuberculosis is 89.39, the specificity is 63.03, the positive predictive value is 0.55, the negative predictive value is 0.92, and the positive predictive value is 0.92, the positive predictive value is 0.92, the positive predictive value is 0.52, and the positive predictive value is 0.92. The likelihood ratio was 2.42, the negative likelihood ratio was 0.17, and the Yorden index was YoudensIndex0.52. In the ROC curve of T-SPOT.TB for the diagnosis of active tuberculosis, the area under the curve of A antigen was 0.89), which was larger than that of B antigen 0.860.When A antigen was obtained, the value of A antigen was 13.5 SFCs/2.5*105PBMC. Diagnostic value is optimal, The Yorden index was 0.71, the sensitivity was 84.100.The specificity of T-SPOT.TB was 86.50.T-SPOT.TB in the ROC curve for the diagnosis of old pulmonary tuberculosis, the area under the curve of A antigen and B antigen was 0.600.58, the diagnostic value of A antigen B antigen was poor in active tuberculosis. Group and non-tuberculosis group, There was statistical difference between the old pulmonary tuberculosis group and the other group. 0.01mb antigen 蠂 2: 91.03P? 0.01A antigen 蠂 ~ 2 ~ (12.99) P? 0.01mb antigen 蠂 ~ 2 ~ (8.56) P? There was no statistical difference between non-tuberculosis group and old pulmonary tuberculosis group. 0. 05? B antigen 蠂 2? The history of BCG vaccination had no statistical significance in the occurrence of false positive. 0. 05%, age "g65 years old, immunity impaired or low, body mass index (BMI) BMIG?" 16. 0 kg/m2, these factors were significantly associated with the occurrence of false negative. Conclusion T-SPOT.TB has high sensitivity and specificity in the diagnosis of active tuberculosis, which can provide an important reference value for the diagnosis of active tuberculosis and is not affected by previous tuberculosis history and BCG vaccination.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R52

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本文編號：1522453