根据感染部位评估 T-SPOT.TB 检测对肺外结核的诊断性能。
Diagnostic performance of T-SPOT.TB for extrapulmonary tuberculosis according to the site of infection.
机构信息
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
出版信息
J Infect. 2011 Nov;63(5):362-9. doi: 10.1016/j.jinf.2011.06.010. Epub 2011 Jul 12.
BACKGROUND
The clinical manifestations of extrapulmonary tuberculosis (E-TB) vary according to site of disease, so we tested the hypothesis that IFN-γ producing T-cell responses also vary in parallel. Therefore we conducted a prospective, blinded, observational study to evaluate the diagnostic performance of blood T-SPOT.TB according to the various sites of E-TB.
METHODS
From April 2008 to August 2010, all patients with suspected E-TB were enrolled at a tertiary hospital in an intermediate TB-burden country. Final diagnosis in patients with suspected E-TB was classified by clinical category.
RESULTS
A total of 368 patients with suspected E-TB were enrolled; 196 (53%) were classified as having TB, including 119 (32%) with confirmed TB, 34 (9%) probable TB, and 43 (12%) possible TB; the remaining 172 (47%) were classified as not having TB. After excluding patients with possible TB, the T-SPOT.TB was more sensitive in patients with chronic forms of E-TB such as lymph node or osteoarticular TB (93%, 95% CI 83%-97%) than in patients with acute forms of E-TB such as TB meningitis or miliary TB (79%, 95% CI 66%-87%, P = 0.03).
CONCLUSIONS
The diagnostic performance of the blood T-SPOT.TB differs among patients with various clinical manifestations of E-TB.
背景
肺外结核（E-TB）的临床表现因病变部位而异，因此我们假设 IFN-γ 产生的 T 细胞反应也会相应变化。因此，我们进行了一项前瞻性、盲法、观察性研究，以评估根据 E-TB 的不同部位，血液 T-SPOT.TB 的诊断性能。
方法
2008 年 4 月至 2010 年 8 月，在一个中结核负担国家的三级医院，所有疑似 E-TB 的患者均被纳入研究。疑似 E-TB 患者的最终诊断根据临床类别进行分类。
结果
共纳入 368 例疑似 E-TB 患者；196 例（53%）被归类为 TB，其中 119 例（32%）为确诊 TB，34 例（9%）为可能 TB，43 例（12%）为可能 TB；其余 172 例（47%）被归类为非 TB。排除可能 TB 患者后，T-SPOT.TB 在慢性 E-TB 形式（如淋巴结或骨关节炎 TB）患者中的敏感性更高（93%，95%CI 83%-97%），而非急性 E-TB 形式（如结核性脑膜炎或粟粒性 TB）患者（79%，95%CI 66%-87%，P=0.03）。
结论
血液 T-SPOT.TB 在不同临床表现的 E-TB 患者中的诊断性能不同。
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