CAJ | 학술논문

目的探讨结核感染T细胞斑点实验(T-SPOT.TB) T-SPOT.TB对结缔组织病(CTD)合并结核感染的辅助诊断价值.方法病例对照研究.选取2011年9月至2012年7月中南大学湘雅医院风湿免疫科收治的CTD合并结核感染患者44例,并随机选取同期未有结核感染的CTD患者44例作为对照,比较结核感染T细胞斑点实验(T-SPOT.TB)和结核菌素皮肤试验(TST)对CTD合并结核感染患者的辅助诊断价值,评价两组T-SPOT.TB结果斑点形成细胞频数,分析导致T-SPOT.TB假阴性的相关危险因素,采用t检验x2检验及受试者操作特征(ROC)曲线进行统计学分析.结果 T-SPOT.TB诊断CTD合并结核感染的敏感度为70.5％(31/44),显著高于TST(27.3％,12/44,x2=16.42,P＜0.001),两项指标的特异度分别为93.2％(41/44)和88.6％(39/44),差异无统计学意义(x2=0.14,P=0.711),T-SPOT.TB诊断CTD合并结核感染的阳性预测值为91.2％ (31/34),阴性预测值为75.9％ (41/54),约登指数为0.64,阳性似然比为10.3,均高于TST(0.16和2.4),而其阴性似然比为0.32,低于TST(0.82).当T-SPOT.TB斑点形成细胞频数取值为38个斑点形成细胞(SFC)/106外周血单个核细胞时,诊断结核感染有最佳截断值.对T-SPOT.TB诊断假阴性分别进行相关危险因素分析,发现年龄、激素或免疫抑制剂的使用、淋巴细胞减少症和低白蛋白血症均不是T-SPOT.TB诊断假阴性的危险因素.结论 T-SPOT.TB对CTD合并结核感染的辅助诊断价值明显高于TST.
목적 탐토결핵감염T세포반점실험(T-SPOT.TB) T-SPOT.TB대결체조직병(CTD)합병결핵감염적보조진단개치.방법 병례대조연구.선취2011년9월지2012년7월중남대학상아의원풍습면역과수치적CTD합병결핵감염환자44례,병수궤선취동기미유결핵감염적CTD환자44례작위대조,비교결핵감염T세포반점실험(T-SPOT.TB)화결핵균소피부시험(TST)대CTD합병결핵감염환자적보조진단개치,평개량조T-SPOT.TB결과반점형성세포빈수,분석도치T-SPOT.TB가음성적상관위험인소,채용t검험x2검험급수시자조작특정(ROC)곡선진행통계학분석.결과 T-SPOT.TB진단CTD합병결핵감염적민감도위70.5％(31/44),현저고우TST(27.3％,12/44,x2=16.42,P＜0.001),량항지표적특이도분별위93.2％(41/44)화88.6％(39/44),차이무통계학의의(x2=0.14,P=0.711),T-SPOT.TB진단CTD합병결핵감염적양성예측치위91.2％ (31/34),음성예측치위75.9％ (41/54),약등지수위0.64,양성사연비위10.3,균고우TST(0.16화2.4),이기음성사연비위0.32,저우TST(0.82).당T-SPOT.TB반점형성세포빈수취치위38개반점형성세포(SFC)/106외주혈단개핵세포시,진단결핵감염유최가절단치.대T-SPOT.TB진단가음성분별진행상관위험인소분석,발현년령、격소혹면역억제제적사용、림파세포감소증화저백단백혈증균불시T-SPOT.TB진단가음성적위험인소.결론 T-SPOT.TB대CTD합병결핵감염적보조진단개치명현고우TST.
Objective To investigate the diagnostic value of the T-SPOT.TB in connective tissue disease(CTD) combined with tuberculosis.Methods This is a case-control study.Forty-four patients with CTD combined with tuberculosis were enrolled from Xiangya Hospital of Central South University from September 2011 to July 2012.Another forty-four CTD patients without tuberculosis were evaluated as a control group.The diagnostic value of T-SPOT.TB and risk factors of the false negative results by T-SPOT.TB were analyzed.Results The sensitivity of T-SPOT.TB (70.5％,31/44) was significantly higher than that of TST(27.3％,12/44) for CTD combined with tuberculosis patients (x2 =16.42,P ＜ 0.001).The specificity of T-SPOT.TB and TST were 93.2％ (41/44) and 88.6％ (39/44),respectively.There was no significant difference between the specificity (x2 =0.14,P =0.711).The positive predictive value of T-SPOT.TB was 91.2％ (31/34).The negative predictive value was 75.9％ (41/54).Youden's index was 0.64,and the positive likelihood ratio was 10.3.All the index were higher than that of TST (0.16 and 2.4).While the negative likelihood ratio which was 0.32 was lower than that of TST (0.82).When spot forming cell frequencies of T-SPOT.TB of PBMC was set to 38SFCs/106 PBMC,it had the best cut-off value.Age,use of glucocorticoids or immunosuppressant therapy,lymphocytopenia and hypoalbuminemia were not associated with false negative T-SPOT.TB assay.Conclusion The T-SPOT.TB assay is much more useful than TST for diagnosing CTD combined with tuberculosis.