生堡缱焦塑哩哩苤盍!!!!生!旦箜!!鲞筮!塑g!也』!!!!竺壁!P鱼旦立丛业!!!!：!!!：!!：盟!：17一干扰素释放试验检测胸腔积液对诊断结核性胸膜炎的初步探讨刘菲张霞杜凤娇潘丽萍刘洋贾红彦邢爱英杜博平孙琦古淑香张宗德【摘要】目的通过比较胸腔积液的结核感染T细胞斑点试验(T·SPOT．TB)和腺苷脱氨酶(ADA)等常规检测，评价T—SPOT．TB在结核性胸膜炎诊断中的价值。方法将2011年6月至2012年11月在北京胸科医院住院的胸腔积液患者(除外诊断不明确和临床诊断结核性胸膜炎病例)111例，分为确诊结核性胸膜炎组(59例)和非结核性胸膜炎组(52例)。对所有患者的胸腔积液进行T—SPOT．TB和ADA检测。两组T—SPOT．TB的斑点形成细胞(SFC)数量比较采用Mann—WhitneyU检验，两种检测方法诊断结核性胸膜炎的敏感度和特异度比较采用x2检验。结果根据两组胸腔积液T—SPOT．TB检测的SFC数确定T—SPOT．TB诊断结核性胸膜炎的界值为216／106胸腔积液单个核细胞。T—SPOT．TB诊断结核性胸膜炎的敏感度(91．5％，54／59)显著高于ADA(71．2％，42／59)，差异有统计学意义(x2=8．045，P<0．01)；T—SPOT．TB诊断结核性胸膜炎的特异度(90．4％，47／52)与ADA(92．0％，46／50)的差异无统计学意义(x2=0．000，P>0．05)。胸腔积液T-SPOT．TB和ADA检测的受试者工作特征曲线下面积分别为0．912和0．903。两种方法联合检测胸腔积液的敏感度降至67．8％(40／59)，但特异度升至100．o％(50／50)。结论T—SPOT．TB检测胸腔积液是较准确的辅助诊断结核性胸膜炎的方法，与ADA联合检测可显著提高诊断的特异度。【关键词】结核，胸膜；胸腔积液；腺苷脱氨酶；-y-干扰素释放试验Comparisonofinterferon-gammareleaseassaysandadenosinedeaminaseofpleuralfluidforthediagnosisofpleuraituberculosisLiuFei，ZhangXia，DuFengjiao，PanLiping，LiuYang，JiaHongyan，XingAiying，DuBoping，SunQi，GMShuxiang，ZhangZougdBBeijingKeyLaboratoryforDrugResistantTuberculosisResearch，BeijingChestHospital，CapitalMedicalUniversity，BeingTuberculosisandThoracicTumorResearchInstitute，Beijing101149，ChinaCorrespondingauthor：ZhangZongde，Email：zzdgl7@163．con【Abstract】ObjectiveTocomparethediagnosticperformanceofinterferongammareleasingassays(T—SPOT．TB)andadenosinedeaminase(ADA)inpleuraltuberculosis，andthereforetoevaluatethevalueofT．SPOT．TBinahightuberculosisburdencountry．MethodsFromJune2011toNovember2012．11lpatientswithpleuralfluidinBeijingChestHospital，CapitalMedicalUniversitywereenrolledprospectivelyandcategorizedasculture／biopsy．confirmedpleuraltuberculosisgroup(n=59)andnon—pleuraltuberculosisgroup(n=52)．Patientswithuncertaindiagnosisandclinicallydiagnosedpleuraltuberculosiswereexcludedfromthestudy．PleuralfluidT—SPOT．TBandADAmeasurementswereperformed，inadditiontootherroutinelaboratorytests．Continuousvariables(spotformingcells，SFCs)werecomparedusingnonparametricMann—WhitneyUtest．ComparisonsbetweenproportionswereperformedusingChi—squaredtest．ResultsThereceiveroperatingcharacteristic(ROC)curveandcut—offvalueofpleuralfluidT—SPOT．TBwereestablishedaccordingtospotformingcells(SFC)betweenculture／biopsy—confirmedpleuraltuberculosisgroupandnon．pleuraltuberculosisgroup(216SFC／106pleuralfluidmononuclearcells)．ThesensitivityofpleuralfluidT—SPOT．TBandADAwas91．5％(54／59)and71．2％(42／59)，respectively．Thespecificitywas90．4％(47／52)and92．0％(46／50)．respectively．ThesensitivityofpleuralfluidT—SPOT．TBwassignificantly验室DOI：10．3760／cmmj．issn．1001旬939．2014．05．003基金项目：国家科技重大专项课题(2012ZXl0003002)；首都医学发展科研基金(2009—3146)作者单位：101149首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所耐药结核病北京市重...
