【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

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