脑脊液T细胞干扰素-γ释放试验对结核性脑膜炎的诊断价值
Diagnostic Value of T-Cell Interferon-γ Release Assays on Cerebrospinal Fluid for Tuberculous Meningitis.
作者信息
Qin Ling, Zhang Lifan, Zhang Yueqiu, Shi Xiaochun, Zhang Yao, Liu Xiaoqing
机构信息
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.
出版信息
PLoS One. 2015 Nov 6;10(11):e0141814. doi: 10.1371/journal.pone.0141814. eCollection 2015.
UNLABELLED
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
CSFMC
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.
CSFMC
PBMC T-SPOT.TB ratio might be useful for the early diagnosis of TBM.
未标注
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。
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