ADA、TB-DNA、T-spot单用或联合检测对结核性胸膜炎早期诊断的临床意义*

Clinical significance of ADA, TB-DNA, T-spot alone or combined detection in early diagnosis and prognosis prediction of tuberculous pleurisy*

摘要:

目的 探究腺苷脱氨酶（ADA）、胸水结合分歧杆菌脱氧核糖核酸（TB-DNA）、结核感染T细胞斑点实验（T-spot）或联合检测在结核性胸膜炎（TBP）早期诊断的临床意义。方法 回顾性选取上虞人民医院2016年6月—2018年6月疑似TBP患者76例作为研究对象，以经皮穿刺胸膜活检确诊为TBP患者48例作为TBP组，其余非TBP胸膜炎患者28例作为非TBP组，检测并比较两组胸腔积液中ADA，TB-DNA和外周血T-spot水平。并分析单独检测和3种方法平行联合诊断的诊断效能。结果 TBP组ADA水平高于非TBP组，TBP组的TB-DNA和T-spot阳性率也高于非TBP组（P?<0.05）。ADA和TB-DNA具有较高的特异性（85.71%和96.43%），T-spot的敏感性（81.25%）高于ADA和TB-DNA（P?<0.05），其特异性低于ADA和TB-DNA（71.42%）（P?<0.05）。ADA+T-spot和ADA+TB-DNA+T-spot的敏感性（87.50%和91.67%）和阴性预测值（77.78 % 和82.61%）均高于ADA+TB-DNA（68.75%和62.50%）（P?<0.05）。而ADA+TB-DNA的特异性（89.29%）高于ADA+T-spot和ADA+TB-DNA+T-spot（60.71%和67.86%）（P?<0.05）。TB-DNA+T-spot、ADA+T-spot及ADA+TB-DNA+T-spot平行联合检测的曲线下面积分别为0.666（95% CI：0.614，0.879）、0.849（95% CI：0.802，0.989）和0.917（95% CI：0.831，1.000）。结论 ADA、TB-DNA和T-spot 3种方法各有特点，T-spot敏感性较好，ADA和TB-DNA特异性高，3种方法平行联合检测可提高TBP诊断的敏感性。

Abstract:

Objective To analyze the clinical significance of adenosine deaminase (ADA), TB-DNA, T-spot alone or combined detection in early diagnosis and prognosis prediction of tuberculous pleurisy (TBP). Methods Seventy-six patients with suspected TBP were selected from June 2016 to June 2018, retrospectively. 48 patients with TBP were diagnosed as TBP in patients with non-TBP pleurisy and 28 patients were selected in non-TBP group. The levels of adenosine deaminase (ADA), tuberculosis deoxyribonucleic acid (TB-DNA) and peripheral blood tuberculosis infected T cell spot test (T-spot) were detected and compared between the two groups. The diagnostic efficacy of separate detection and parallel combination diagnosis of three methods was analyzed. Results The ADA level in the TBP group was significantly higher than that in the non-TBP group. The TB-DNA and T-spot positive rates in the TBP group were also significantly higher than those in the non-TBP group (P??0.05), but were significantly higher than ADA+TB-DNA (68.75% and 62.50%) (P?< 0.05). The specificity of the ADA+TB-DNA group (89.29%) was significantly higher than that of the ADA+T-spot and ADA+TB-DNA+ T-spot groups (60.71% and 67.86%). The areas under the curve of TB-DNA+T-spot, ADA+T-spot and ADA+TB-DNA+T-spot were 0.666 (95% CI: 0.614, 0.879), 0.849 (95% CI: 0.802, 0.989) and 0.917 (95% CI: 0.831, 1.000). Conclusion ADA, TB-DNA and T-spot have their own characteristics. The sensitivity and specificity of T-spot are good, while ADA and TB-DNA are highly specific. Parallel combined detection of the three methods can improve the diagnosis sensitivity of TBP.