[干扰素-γ释放试验与胸腔积液腺苷脱氨酶在诊断结核性胸膜炎中的比较]

[Comparison of interferon-gamma release assays and adenosine deaminase of pleural fluid for the diagnosis of pleural tuberculosis].

作者信息

Liu Fei, Zhang Xia, Du Fengjiao, Pan Liping, Liu Yang, Jia Hongyan, Xing Aiying, Du Boping, Sun Qi, Gu Shuxiang, Zhang Zongde

机构信息

Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.

Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China. Email:

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2014 May;37(5):323-7.

PMID:25011504

Abstract

OBJECTIVE

To compare the diagnostic performance of interferon gamma releasing assays (T-SPOT. TB) and adenosine deaminase (ADA) in pleural tuberculosis, and therefore to evaluate the value of T-SPOT. TB in a high tuberculosis burden country.

METHODS

From June 2011 to November 2012, 111 patients with pleural fluid in Beijing Chest Hospital, Capital Medical University were enrolled prospectively and categorized as culture/biopsy-confirmed pleural tuberculosis group (n = 59) and non-pleural tuberculosis group (n = 52). Patients with uncertain diagnosis and clinically diagnosed pleural tuberculosis were excluded from the study. Pleural fluid T-SPOT. TB and ADA measurements were performed, in addition to other routine laboratory tests. Continuous variables (spot forming cells, SFCs) were compared using nonparametric Mann-Whitney U test. Comparisons between proportions were performed using Chi-squared test.

RESULTS

The receiver operating characteristic (ROC) curve and cut-off value of pleural fluid T-SPOT. TB were established according to spot forming cells (SFC) between culture/biopsy-confirmed pleural tuberculosis group and non-pleural tuberculosis group (216 SFC/10(6) pleural fluid mononuclear cells). The sensitivity of pleural fluid T-SPOT. TB and ADA was 91.5% (54/59) and 71.2% (42/59), respectively. The specificity was 90.4% (47/52) and 92.0% (46/50), respectively. The sensitivity of pleural fluid T-SPOT. TB was significantly higher than that of ADA (χ(2) = 8.045, P < 0.01). There was no significant difference of specificity between pleural fluid T-SPOT. TB and ADA (χ(2) = 0.000, P > 0.05). The area under the ROC curve was 0.912 for pleural fluid T-SPOT. TB and 0.903 for ADA. The sensitivity of combination diagnosis of ADA and pleural fluid T-SPOT. TB decreased to 67.8% (40/59), but the specificity increased to 100.0% (50/50).

CONCLUSIONS

Pleural fluid T-SPOT. TB are relatively accurate supplementary assays for the diagnosis of pleural tuberculosis in this high tuberculosis burden country, and the combination of pleural fluid ADA and T-SPOT. TB is of diagnostic value.

摘要

目的

比较干扰素γ释放试验（T-SPOT.TB）和腺苷脱氨酶（ADA）在胸膜结核诊断中的性能，从而评估T-SPOT.TB在结核病高负担国家的价值。

方法

2011年6月至2012年11月，前瞻性纳入首都医科大学附属北京胸科医院111例胸腔积液患者，分为培养/活检确诊的胸膜结核组（n = 59）和非胸膜结核组（n = 52）。排除诊断不明确和临床诊断为胸膜结核的患者。除其他常规实验室检查外，还进行了胸腔积液T-SPOT.TB和ADA检测。连续变量（斑点形成细胞，SFCs）采用非参数Mann-Whitney U检验进行比较。比例之间的比较采用卡方检验。

结果

根据培养/活检确诊的胸膜结核组和非胸膜结核组之间的斑点形成细胞（SFC）确定胸腔积液T-SPOT.TB的受试者操作特征（ROC）曲线和临界值（216 SFC/10(6)胸腔积液单个核细胞）。胸腔积液T-SPOT.TB和ADA的敏感性分别为91.5%（54/59）和71.2%（42/59）。特异性分别为90.4%（47/52）和92.0%（46/50）。胸腔积液T-SPOT.TB的敏感性显著高于ADA（χ(2)=8.045，P<0.01）。胸腔积液T-SPOT.TB和ADA之间的特异性无显著差异（χ(2)=0.000，P>0.05）。胸腔积液T-SPOT.TB的ROC曲线下面积为0.912，ADA为0.903。ADA和胸腔积液T-SPOT.TB联合诊断的敏感性降至67.8%（40/59），但特异性增至100.0%（50/50）。