胡钰卿　潘爱珍　王静　朱敏

[摘要] 目的 分析探讨感染T细胞斑点试验（T-SPOT.TB）在耐多药肺结核诊断中的应用价值。 方法 选择2014年1月～2016年1月我院收治的耐多药肺结核患者71例，另选择35例同期健康体检者作为对照组，比较各种检测方法诊断的阳性率，并采用敏感性、特异性、准确度作为诊断试验的评价指标。 结果 T-SPOT.TB检测诊断耐多药肺结核阳性率最高，达95.8%，显著高于其他各项检测方法，差异具有统计学意义（P<0.05）。抗酸杆菌涂片、结核菌培养、T-SPOT.TB检测用于诊断耐多药肺结核的敏感性较高，达90%以上。T-SPOT.TB检测用于诊断耐多药肺结核的特异性最高，达91.9%，显著高于其他各项检测方法，差异具有统计学意义（P<0.05）。T-SPOT.TB检测用于诊断耐多药肺结核的准确度最高，达96.2%，显著高于其他各项检测方法，差异具有统计学意义（P<0.05）。 结论 与其他检查方法相比，感染T细胞斑点试验对诊断耐多药肺结核具有特异性高、准确度高的优点，值得广泛推广和应用。

[关键词] 耐多药肺结核；感染T细胞斑点试验； 敏感性；特异性

[中图分类号] R521 [文献标识码] B [文章编号] 1673-9701（2016）25-0070-04

Application value of T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis

HU Yuqing1 PAN Aizhen2 WANG Jing1 ZHU Min1

1.Tuberculosis Laboratory， Hangzhou Red Cross Hospital， Hangzhou 310003， China； 2.Tuberculosis Laboratory， Center for Tuberculosis Prevention and Control， Zhejiang Center for Disease Control， Hangzhou 310051， China

[Abstract] Objective To analyze the application value of T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis. Methods A total of 71 patients with multi-drug resistant tuberculosis who were admitted to our hospital from January 2014 to January 2016 were selected. Another 35 healthy subjects were selected as the control group. The diagnosis positive rate of each test method was compared， and sensitivity， specificity and accuracy were applied as the evaluation indicators of the diagnostic test. Results The positive rate of T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis was the highest， reaching up to 95.8%， significantly higher than that of other test methods， and the differences were statistically significant（P<0.05）. The sensitivity of acid-fast bacillus test， tuberculous bacillus culture and T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis was higher， reaching over 90%. The specificity of T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis was the highest， reaching up to 91.9%， significantly higher than that of other test methods， and the differences were statistically significant（P<0.05）. The accuracy of T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis was the highest， reaching up to 96.2%， significantly higher than that of other test methods， and the differences were statistically significant（P<0.05）. Conclusion Compared with other test methods， T-SPOT.TB test in the diagnosis of multi-drug resistant tuberculosis has advantages of high specificity and high accuracy， which is worthy of wide promotion and application.

[Key words] Multi-drug resistant tuberculosis； T-SPOT.TB test； Sensitivity； Specificity

结核病是一种慢性传染病，是由结核分枝杆菌感染引起的疾病，其中最为常见的是肺部结核。近年来全球结核病疫情呈回升状态，耐药结核菌发生率不断增加[1，2]。其中，耐多药肺结核指结核菌至少同时对利福平、异烟肼两种抗结核药物耐药，发病率较高，约占全世界25.0%，还存在持续向外播散耐多药结核菌情况。耐多药肺结核治疗难度大，治疗周期长，治愈率低，因此，寻找特异的检测方法，快速且准确诊断是结核病控制的关键问题，且对于监测结核病的发展、转归及临床治疗具有重要意义。结核菌素试验（purified protein derivative tuberculin，PPD）为诊断结核病的主要方法，但假阳性率较高。结核感染T细胞斑点试验（TB infection of T cells spot test，T-SPOT.TB）为一种新型的诊断方法，敏感性和特异性水平较高。本研究选取耐多药肺结核病例行T-SPOT.TB试验，现报道如下。

1 资料与方法

1.1 一般资料

选择2014年1月～2016年1月我院收治的耐多药肺结核患者71例，入选研究对象均知情同意，均排除合并严重心、脑、肝、肾、消化系统等疾病者。……