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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-Whitney U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100.0％ (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.“,”Objective To compare the diagnostic performance of interferon gamma releasing assays (T-SPOT.TB) and adenosine deaminase (ADA) in pleural tuberculosis,and therefore to evaluate the value of T-SPOT.TB in a high tuberculosis burden country.Methods From June 2011 to November 2012,111patients with pleural fluid in Beijing Chest Hospital,Capital Medical University were enrolled prospectively and categorized as culture/biopsy-confirmed pleural tuberculosis group (n =59) and non-pleural tuberculosis group (n =52).Patients with uncertain diagnosis and clinically diagnosed pleural tuberculosis were excluded from the study.Pleural fluid T-SPOT.TB and ADA measurements were performed,in addition to other routine laboratory tests.Continuous variables (spot forming cells,SFCs) were compared using nonparametric Mann-Whitney U test.Comparisons between proportions were performed using Chi-squared test.Results The receiver operating characteristic (ROC) curve and cut-off value of pleural fluid T-SPOT.TB were established according to spot forming cells (SFC) between culture/biopsy-confirmed pleural tuberculosis group and non-pleural tuberculosis group (216 SFC/106 pleural fluid mononuclear cells).The sensitivity of pleural fluid T-SPOT.TB and ADA was 91.5％ (54/59) and 71.2％ (42/59),respectively.The specificity was 90.4％ (47/52) and 92.0％ 46/50),respectively.The sensitivity of pleural fluid T-SPOT.TB was significantly higher than that of ADA (x2 =8.045,P ＜ 0.01).There was no significant difference of specificity between pleural fluid T-SPOT.TB and ADA (x2 =0.000,P ＞0.05).The area under the ROC curve was 0.912 for pleural fluid T-SPOT.TB and 0.903 for ADA.The sensitivity of combination diagnosis of ADA and pleural fluid T-SPOT.TB decreased to 67.8％ (40/59),but the specificity increased to 100.0％ (50/50).Conclusions Pleural fluid T-SPOT.TB are relatively accurate supplementary assays for the diagnosis of pleural tuberculosis in this high tuberculosis burden country,and the combination of pleural fluid ADA and T-SPOT.TB is of diagnostic value.