Qin Ling, Zhang Lifan, Zhang Yueqiu, Shi Xiaochun, Zhang Yao, Liu Xiaoqing
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, 100730, China.
PLoS One. 2015 Nov 6;10(11):e0141814. doi: 10.1371/journal.pone.0141814. eCollection 2015.
Diagnosis of tuberculous meningitis (TBM) remains a challenge. This study aimed to evaluate the performance of T-SPOT.TB test on cerebrospinal fluid mononuclear cells (CSFMCs) for suspected TBM patients. 43 consecutive patients with suspected TBM were enrolled in the study from June 2011 to September 2014. T-SPOT.TB was performed on both CSFMCs and peripheral blood mononuclear cells (PBMCs). The final diagnosis of TBM was independent of the T-SPOT.TB result. The diagnostic sensitivity, specificity, predictive value, and likelihood ratio of T-SPOT.TB on CSFMCs and PBMCs were analyzed. Of the 43 patients, 12 (27.9%) were finally diagnosed with TBM, 28 (65.1%) with non-TBM, and 3 (7.0%) with indeterminate diagnoses. Of 40 cases with definite diagnoses, the sensitivity and specificity were 92.0% and 96.0% for T-SPOT.TB on CSFMCs, and 83.0% and 82.0% for T-SPOT.TB on PBMCs, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of T-SPOT.TB on CSFMCs were 85.0% and 96.0%, respectively. The PPV and NPV were 67.0% and 92.0% for T-SPOT.TB on PBMCs. The difference of T-SPOT.TB between CSFMCs and PBMCs was not significant so far as sensitivity, specificity, PPV, and NPV were concerned (P>0.05 for each). However, T-SPOT.TB on CSFMC and
PBMC in TBM cases seemed higher than that in non-TBM cases. Our study further showed that T-SPOT.TB on CSFMCs might be a rapid and accurate diagnostic test for TBM.
PBMC T-SPOT.TB ratio might be useful for the early diagnosis of TBM.
结核性脑膜炎（TBM）的诊断仍然是一项挑战。本研究旨在评估T-SPOT.TB检测对疑似TBM患者脑脊液单核细胞（CSFMCs）的诊断效能。2011年6月至2014年9月，连续纳入43例疑似TBM患者。对CSFMCs和外周血单核细胞（PBMCs）均进行T-SPOT.TB检测。TBM的最终诊断与T-SPOT.TB结果无关。分析了T-SPOT.TB对CSFMCs和PBMCs的诊断敏感性、特异性、预测值和似然比。43例患者中，12例（27.9%）最终诊断为TBM，28例（65.1%）为非TBM，3例（7.0%）诊断不明确。在40例明确诊断的病例中，T-SPOT.TB对CSFMCs的敏感性和特异性分别为92.0%和96.0%，对PBMCs的敏感性和特异性分别为83.0%和82.0%。T-SPOT.TB对CSFMCs的阳性预测值（PPV）和阴性预测值（NPV）分别为85.0%和96.0%。T-SPOT.TB对PBMCs的PPV和NPV分别为67.0%和92.0%。就敏感性、特异性、PPV和NPV而言，CSFMCs和PBMCs之间T-SPOT.TB的差异无统计学意义（各项P>0.05）。然而，TBM病例中CSFMC的T-SPOT.TB与PBMC的T-SPOT.TB比值似乎高于非TBM病例。我们的研究进一步表明，CSFMCs上的T-SPOT.TB可能是一种快速准确的TBM诊断检测方法。CSFMC:PBMC的T-SPOT.TB比值可能有助于TBM的早期诊断。
