年龄对腺苷脱氨酶和γ- 干扰素释放实验诊断结核性胸膜炎敏感性的影响

Comparison of sensitivity of ADA and T-SPOT.TB for patients with tuberculous pleural effusion in different age groups

摘要:

目的 比较腺苷脱氨酶（ADA）和γ- 干扰素释放实验T-SPOT.TB 在不同年龄组结核性胸膜炎患者的诊断敏感性。方法 对2015 年1 月-2016 年8 月该院以未明原因胸腔积液住院且已进行ADA 或T-SPOT.TB 检查的、最终确诊为结核性胸膜炎的271 例患者进行回顾性分析。入组患者根据其所做检查，分为ADA 组和T-SPOT.TB 组，再将每组患者根据年龄分为0 ～ 30 岁、31 ～ 50 岁、51 ～ 70 岁、≥ 71 岁4 组，分别计算各组2 项检查的敏感性。组间比较采用Kruskal-Wallis 检验。结果 入组患者中，接受ADA 检查 的患者有129 例，接受T-SPOT.TB 检查的患者有142 例。ADA 诊断结核性胸膜炎的总体敏感性为72.86%，T-SPOT.TB 诊断结核性胸膜炎的总体敏感性为90.14%。各年龄段ADA 和T-SPOT.TB 的敏感性分别为：0～ 30 岁，85.41% 和94.64% ；31 ～ 50 岁，69.44% 和81.08% ；51 ～ 70 岁，55.88% 和80.55% ；≥ 71 岁，42.85%和72.72%。年龄相关的敏感性变化在ADA 和T-SPOT.TB 检查中均有不同，差异有统计学意义（P =0.002和0.047）。结论 T-SPOT.TB 诊断结核性胸膜炎的敏感性高于ADA，ADA 和T-SPOT.TB 对中青年患者结核性胸膜炎诊断敏感性均高于老年患者，应用于老年患者时应考虑假阴性结果。

Abstract:

Objective To evaluate the influence of age on the sensitivity of adenosine deaminase (ADA) and interferon-gamma release assays (T-SPOT.TB) in diagnosing tuberculous pleurisy. Methods A total of 271 patients with tuberculosis pleural effusion (TPE) in the First Affiliated Hospital of Zhengzhou University from January 2015 to August 2016 were enrolled. Pleural effusion (PE) ADA or whole blood T-SPOT.TB assay was conducted in the 271 patients. The sensitivity of ADA and T-SPOT.TB in different age groups ( ≤ 30 years, 31-50 years, 51-70 years and ≥71 years) was analyzed respectively. Categorical variables were compared by Kruskal-Wallis test. Results All patients were divided into ADA group (n = 129) and T-SPOT.TB group (n = 142). The overall sensitivity of ADA and T-SPOT.TB was 72.86 % and 90.14 % respectively. The sensitivity of ADA and T-SPOT.TB according to age was as follows: ≤ 30 years, 85.41% and 94.64%; 31-50 years, 69.44 % and 81.08%; 51-70 years, 55.88 % and 80.55 %; ≥71 years, 42.85 % and 72.72%, respectively. The changes of sensitivity according to age were significant in both ADA group (P = 0.002) and T-SPOT.TB group (P = 0.047). Conclusions T-SPOT.TB has relatively higher sensitivity than ADA in diagnosing tuberculous pleurisy. The sensitivity of the two assays has a declining trend as the age increases.So it is necessary for clinicians to be aware of the false negative results in elderly patients.