發(fā)布時(shí)間：2018-10-07 19:36

【摘要】：目的:評(píng)價(jià)T-SPOT.TB在肺外結(jié)核病診斷中的應(yīng)用價(jià)值。方法:回顧性納入2013年1月~2015年12月中國(guó)人民解放軍第309醫(yī)院病理科應(yīng)用PCR反向斑點(diǎn)雜交法進(jìn)行分枝桿菌菌種鑒定(以下簡(jiǎn)稱分子病理)肺外組織標(biāo)本280例,病案檢索其外周血T-SPOT.TB檢測(cè)結(jié)果,將檢測(cè)結(jié)果與分子病理診斷結(jié)果進(jìn)行比較,以敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、陽(yáng)性似然比、陰性似然比為評(píng)價(jià)指標(biāo)。結(jié)果:以分子病理診斷與T-SPOT.TB比較,280例患者中T-SPOT.TB陽(yáng)性170例,陰性110例;分子病理MCH陽(yáng)性者1例,MGO陽(yáng)性5例,MTC陽(yáng)性共146例,結(jié)果陰性128例;分子病理陽(yáng)性且T-SPOT.TB陽(yáng)性共148例,分子病理陰性且T-SPOT.TB陽(yáng)性共22例,分子病理陽(yáng)性且T-SPOT.TB陰性共4例,分子病理陰性且T-SPOT.TB陰性共106例。敏感性為97.4%(148/152),特異性為82.8%(106/128),陽(yáng)性預(yù)測(cè)值為87.0%(148/170),陰性預(yù)測(cè)值為96.4%(106/110),陽(yáng)性似然比為5.69,陰性似然比為0.0318。其中骨關(guān)節(jié)脊柱分子病理例數(shù)較多,占54.64%(153/280)敏感度80.0%(60/75),特異度100.0%(78/78),陽(yáng)性預(yù)測(cè)值100.0%(60/60),陰性預(yù)測(cè)值83.9%(78/93);以臨床診斷與T-SPOT.TB比較,280例患者中T-SPOT.TB陽(yáng)性170例,T-SPOT.TB陰性110例,臨床診斷結(jié)果陽(yáng)性192例,臨床診斷結(jié)果陰性88例。臨床診斷陽(yáng)性且T-SPOT.TB陽(yáng)性145例,臨床診斷陰性且T-SPOT.TB陽(yáng)性25例,臨床診斷陽(yáng)性且T-SPOT.TB陰性47例,臨床診斷陰性且T-SPOT.TB陰性63例。敏感性為75.5%(145/192),特異性為42.7%(63/88),陽(yáng)性預(yù)測(cè)值為85.3%(145/170),陰性預(yù)測(cè)值為57.3%(63/110),陽(yáng)性似然比為2.66,陰性似然比為0.342。結(jié)論:本研究顯示T-SPOT.TB檢測(cè)對(duì)肺外結(jié)核診斷具有較高的敏感性,可對(duì)臨床診斷提供有利的依據(jù)。較高的T-SPOT.TB陰性預(yù)測(cè)值提示對(duì)于排除肺外結(jié)核病有重要意義。
[Abstract]:Objective: to evaluate the value of T-SPOT.TB in the diagnosis of extrapulmonary tuberculosis. Methods: from January 2013 to December 2015, 280 specimens of extrapulmonary tissues from the Department of Pathology of the 309th Hospital of the Chinese people's Liberation Army (PLA) were identified by PCR reverse dot blot hybridization. The results of T-SPOT.TB in peripheral blood were searched and compared with the results of molecular pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were used as the evaluation indexes. Results: compared with T-SPOT.TB by molecular pathology, 170 cases were positive for T-SPOT.TB, 110 cases were negative, 1 case was positive for MCH, 1 case was positive for MCH, and 128 cases were negative for T-SPOT.TB, 148 cases were positive in molecular pathology and T-SPOT.TB. There were 22 cases with positive molecular pathology and T-SPOT.TB positive, 4 cases with positive molecular pathology and negative T-SPOT.TB, 106 cases with negative molecular pathology and negative T-SPOT.TB. The sensitivity was 97.4% (148 / 152), the specificity was 82.8% (106 / 128), the positive predictive value was 87.0% (148170), the negative predictive value was 96.4% (106 / 110), the positive likelihood ratio was 5.69, the negative likelihood ratio was 0.0318. Among them, 54.64% (153 / 280) had 80.0% (60 / 75) sensitivity, 100.0% (78 / 78) specificity, 100.0% (60 / 60) positive predictive value and 83.9% (78 / 93) negative predictive value. The clinical diagnosis was negative in 88 cases. There were 145 cases with positive clinical diagnosis and T-SPOT.TB positive, 25 cases with negative clinical diagnosis and T-SPOT.TB positive, 47 cases with positive clinical diagnosis and T-SPOT.TB negative, 63 cases with negative clinical diagnosis and T-SPOT.TB negative. The sensitivity was 75.5% (145 / 192), the specificity was 42.7% (63 / 88), the positive predictive value was 85.3% (145 / 170), the negative predictive value was 57.3% (63 / 110), the positive likelihood ratio was 2.66, the negative likelihood ratio was 0.342. Conclusion: this study shows that T-SPOT.TB has a high sensitivity in the diagnosis of extrapulmonary tuberculosis and can provide a favorable basis for clinical diagnosis. The higher T-SPOT.TB negative predictive value suggests that it is important to exclude extrapulmonary tuberculosis.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R52

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周玉利;周青雪;;T-SPOT.TB陽(yáng)性標(biāo)本抗原ESAT-6和CFP-10相關(guān)性的探討[J];浙江臨床醫(yī)學(xué);2015年08期

2 吳旺社;江晨;蘇寧;;利福平引起超敏反應(yīng)綜合癥兩例并文獻(xiàn)復(fù)習(xí)[J];臨床肺科雜志;2014年01期

3 李娜;邱珊;;458份痰抗酸染色涂片和結(jié)核桿菌快速培養(yǎng)的結(jié)果比較[J];甘肅醫(yī)藥;2013年10期

4 劉珍瓊;段永和;張齊龍;葉琳;邊澤源;;T-SPOT.TB技術(shù)檢測(cè)胸腔積液在結(jié)核性胸膜炎診斷中的應(yīng)用[J];實(shí)驗(yàn)與檢驗(yàn)醫(yī)學(xué);2013年04期

5 劉萍;辛濤;劉向;;利福平過(guò)敏反應(yīng)25例臨床觀察[J];新疆醫(yī)學(xué);2013年04期

6 周建華;;痰涂片法與痰培養(yǎng)法檢測(cè)抗酸桿菌結(jié)果比較[J];中國(guó)鄉(xiāng)村醫(yī)藥;2013年05期

7 趙俊;左濤;;利福平致藥物熱129例的臨床觀察[J];醫(yī)藥導(dǎo)報(bào);2012年09期

8 王黎霞;成詩(shī)明;陳明亭;趙雁林;張慧;姜世聞;何廣學(xué);呂青;杜昕;陳偉;劉小秋;阮云洲;王勝芬;夏aa;于蘭;李峻;李雪;;2010年全國(guó)第五次結(jié)核病流行病學(xué)抽樣調(diào)查報(bào)告[J];中國(guó)防癆雜志;2012年08期

9 韓駿鋒;李麗;吳琦;;利福平致急性腎功能衰竭8例分析并文獻(xiàn)復(fù)習(xí)[J];中國(guó)防癆雜志;2010年06期

10 霍霏霏;張麗帆;劉曉清;;評(píng)價(jià)γ干擾素釋放分析T-SPOT.TB在肺外結(jié)核病診斷中的敏感性[J];中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào);2009年04期

相關(guān)會(huì)議論文 前1條

1 鄧國(guó)防;雷建平;;抗結(jié)核藥物致超敏反應(yīng)32例臨床分析[A];結(jié)核病和呼吸疾病診治進(jìn)展及治療中肝損害專題研討會(huì)資料匯編[C];2013年

，

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