T-SPOT在儿童结核病诊断中的价值

Diagnostic value of T-SPOT for tuberculosis in children

摘要:

目的探讨T淋巴细胞酶联免疫斑点法（TSPOT）在儿童结核病（TB）诊断中的应用价值。方法选取2015年3月—2016年5月某院收治并确诊的TB患儿43例作为结核组，随机选取同期在该院门诊及住院部排除结核感染的患儿及健康儿童50例作为对照组，分别对两组进行TSPOT﹑PPD﹑结核抗体（MTBAb）及涂片抗酸染色等四种方法检测和对比分析，并对TSPOT法在结核组不同感染部位、不同年龄段患者的阳性情况进行亚组分析。结果TSPOT在灵敏度和阴性预测值方面高于其余三种方法（P＜0.05），特异度也高于PPD法（P＜0.05）；TSPOT在肺内结核和肺外结核中检出的阳性率分别为88.9%和81.3%，差异无统计学意义（P＞0.05）；在≤5岁和＞5岁儿童两组之间的检出率分别为70.6%和96.2%，差异有统计学意义（P＜0.05 ）。采用TSPOT法和PPD法两种方法进行并联模式的结核检测时的灵敏度为95.3%，特异度为98.0%，相比于单一方法检测均有提高（P＜0.05）。结论TSPOT法在儿童TB检测方面相对于传统方法在灵敏度和特异度上均有优势，也适用于肺外结核的检测，可作为儿童结核实验室诊断的主要方法，但在5岁以下儿童存在不确定性，应合理联合PPD法检测，才能更好发挥在儿童TB诊断中的价值。

Abstract:

ObjectiveTo investigate the value of TSPOT in the diagnosis of tuberculosis（TB） in children. Methods43 children who were admitted to a hospital and confirmed with TB between March 2015 and May 2016 were as TB group, 50 children who were excluded TB as well as healthy children in the outpatient and inpatient departments of this hospital during the same period were as control group, two groups were underwent detection of TSPOT, PPD, MTBAb, and acid fast stain, results were compared, subgroup analysis was conducted on the positive of TSPOT in children with different infection sites and in different age groups. ResultsSensitivity and negative predictive value of TSPOT were significantly higher than the other three methods（P＜0.05），specificity was also higher than that of PPD（P＜0.05）；positive rates of TSPOT in pulmonary tuberculosis and extrapulmonary tuberculosis were 88.9% and 81.3% respectively，difference was not statistically significant（P＞0.05）；positive rates of TSPOT in children ≤5 years and >5 years were 70.6% and 96.2% respectively，difference was statistically significant（P<0.05）. The sensitivity and specificity of combined detection of TSPOT and PPD for diagnosis of TB were 95.3% and 98.0% respectively，which were both higher than the single method（P＜0.05）.ConclusionThe sensitivity and specificity of TSPOT for detecting TB in children are both superior to traditional methods, TSPOT is also suitable for the detection of extrapulmonary tuberculosis, and can be used as the main method for laboratory diagnosis of tuberculosis in children, but it is uncertainty in children under 5 years of age, and should be rationally combined with PPD to improve the diagnosis of TB among children.