CAJ | 학술논문

目的探讨结核感染T淋巴细胞斑点试验(T-SPOT.TB)对发热患者的应用价值.方法以456例发热患者作为研究对象,所有患者在进行相关检查后未能明确发热原因,或不除外结核分枝杆菌感染,进行T-SPOT.TB检测.制作受试者工作特征曲线,对患者的临床诊断和T-SPOT.TB检测结果进行分析.结果本研究中有85例患者临床诊断为结核病,其中肺结核34例.T-SPOT.TB检测阳性、未找到结核病灶、但抗结核治疗有效24例,结核性胸膜炎10例,其他部位结核17例归入肺外结核进行分析;371例患者无明确结核分枝杆菌感染证据(其中42例疑似结核病例,329例为非结核病例).T-SPOT.TB检测在结核患者中的敏感度为84.3％,阴性预测值为94.2％,特异度为68.1％,阳性预测值为41.4％,Kappa值为0.380,受试者工作特征(ROC)曲线下面积为0.762(95％CI:0.707～0.817).T-SPOT.TB检测在肺结核、肺外结核的敏感度分别为78.1％、88.2％,阴性预测值分别为92.6％、95.3％,Kappa值分别为0.299、0.438,ROC曲线下面积分别为0.719(95％CI:0.623～0.815)、0.791(95％CI:0.724～0.857).在329例非结核患者中有99例T-SPOT.TB检测阳性.结论 T-SPOT.TB检测可以在发热患者中发现那些无明确结核感染灶的结核分枝杆菌感染者;因其有较高的阴性预测值,对于排除结核分枝杆菌感染的诊断有重要意义.
목적 탐토결핵감염T림파세포반점시험(T-SPOT.TB)대발열환자적응용개치.방법 이456례발열환자작위연구대상,소유환자재진행상관검사후미능명학발열원인,혹불제외결핵분지간균감염,진행T-SPOT.TB검측.제작수시자공작특정곡선,대환자적림상진단화T-SPOT.TB검측결과진행분석.결과 본연구중유85례환자림상진단위결핵병,기중폐결핵34례.T-SPOT.TB검측양성、미조도결핵병조、단항결핵치료유효24례,결핵성흉막염10례,기타부위결핵17례귀입폐외결핵진행분석;371례환자무명학결핵분지간균감염증거(기중42례의사결핵병례,329례위비결핵병례).T-SPOT.TB검측재결핵환자중적민감도위84.3％,음성예측치위94.2％,특이도위68.1％,양성예측치위41.4％,Kappa치위0.380,수시자공작특정(ROC)곡선하면적위0.762(95％CI:0.707～0.817).T-SPOT.TB검측재폐결핵、폐외결핵적민감도분별위78.1％、88.2％,음성예측치분별위92.6％、95.3％,Kappa치분별위0.299、0.438,ROC곡선하면적분별위0.719(95％CI:0.623～0.815)、0.791(95％CI:0.724～0.857).재329례비결핵환자중유99례T-SPOT.TB검측양성.결론 T-SPOT.TB검측가이재발열환자중발현나사무명학결핵감염조적결핵분지간균감염자;인기유교고적음성예측치,대우배제결핵분지간균감염적진단유중요의의.
Objective To investigate the diagnostic value of T-SPOT.TB in patients with fever.Methods T-SPOT.TB was carried out in 456 febrile patients who had no determined reason for fever or who could not be excluded from infection with Mycobacterium tuberculosis.These patients were followed up for their final clinical diagnosis and the diagnostic value of T-SPOT.TB was evaluated using the receiver operating characteristic (ROC) curve.Results In the present study,85 patients were clinically diagnosed with tuberculosis (TB) (including 34 cases of pulmonary TB,24 cases of TB infection defined as T-SPOT.TB positive without TB lesion,but effective with anti-TB treatment,10 cases of tuberculous pleurisy and 17 cases of other extrapulmonary TB) and 371 patients had no definite evidence of Mycobacterium tuberculosis infection (including 42 cases of suspected TB and 329 cases of other diseases).T-SPOT.TB had a high sensitivity of 84.3％ in TB patients and a high negative predictive value of 94.2 ％,but the specificity was 68.1％ and the positive predictive value was 41.4 ％.The Kappa value was 0.380 and the area under ROC curve was 0.762 (95％CI:0.707-0.817).T-SPOT.TB had a higher sensitivity in extrapulmonary TB than in pulmonary TB (88.2 ％ vs 78.1 ％),with the negative predictive values of 95.3 ％ and 92.6 ％,Kappa values of 0.438 and 0.299,and the areas under ROC of 0.791 (95 ％ CI:0.724-0.857) and 0.719 (95％CI:0.623-0.815),respectively.Ninety-nine cases were T-SPOT.TB positive out of 329 patients diagnosed with other diseases.Conclusions T-SPOT.TB test can be used as a method for TB diagnosis in patients without obvious TB lesions.Due to its relatively high negative predictive value,T-SPOT.TB can be used to rule out infection with Mycobacterium tuberculosis.