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目的:比较γ-干扰素释放实验(T-SPOT.TB)和GeneXpertMTB/RIF 2种方法对结核病的诊断价值。方法:采集273例结核病患者与45例健康对照者全血,采用T-SPOT.TB检测结核特异性抗原致敏T淋巴细胞,同时收集结核病患者痰液标本采用抗酸染色法进行抗酸杆菌筛查、GeneXpertMTB/RIF进行MTB-DNA和利福平(RIF)耐药检测。结果:273例结核病患者中抗酸染色、T-SPOT.TB和GeneXpertMTB/RIF的敏感性分别为26.74%(73/273)、89.74%(245/273)和72.53%(198/273),特异性分别为100%、93.33%和100%,阳性预测值分别为100%、98.79%和100%,阴性预测值分别为18.37%、60.00%和37.50%,准确性分别为37.11%、90.25%和76.42%,3种方法的敏感性差异有统计学意义(χ~2=248.39,P<0.01)。3种方法对肺结核的检出率分别为34.76%(73/210)、90.00%(189/210)和94.29%(198/210),差异有统计学意义(χ~2=234.937,P<0.01)。3种方法对肺外结核的检出率分别为0(0/63)、88.88%(56/63)和0(0/63)。抗酸染色阳性的肺结核患者中TSPOT.TB和GeneXpertMTB/RIF的阳性率分别为93.15%(68/73)和100%(73/73),抗酸染色阴性肺结核患者T-SPOT.TB和Genexpert MTB/RIF的阳性率为88.32%(121/137)和91.24%(125/137)。结论:T-SPOT.TB和GeneXpertMTB/RIF 2种方法对诊断结核病和肺结核的诊断效能明显优于抗酸染色,T-SPOT.TB对肺外结核患者有更高的检出率。
Objective: To compare the diagnostic value of T-SPOT.TB and GeneXpertMTB / RIF in the diagnosis of tuberculosis. Methods: Whole blood was collected from 273 TB patients and 45 healthy controls. T-SPOT.TB was used to detect tuberculosis-specific antigen-primed T lymphocytes. At the same time, sputum samples from patients with tuberculosis were collected and acid-fast bacilli Check, GeneXpertMTB / RIF MTB-DNA and rifampicin (RIF) resistance test. Results: The sensitivities of acid-fast staining, T-SPOT.TB and GeneXpertMTB / RIF in 273 tuberculosis patients were 26.74% (73/273), 89.74% (245/273) and 72.53% (198/273) The positive predictive values were 100%, 98.79% and 100% respectively, and the negative predictive values were 18.37%, 60.00% and 37.50%, respectively, with the accuracy of 37.11% and 90.25%, respectively 76.42%. The sensitivity of the three methods was statistically significant (χ ~ 2 = 248.39, P <0.01). The detection rates of the three methods for tuberculosis were 34.76% (73/210), 90.00% (189/210) and 94.29% (198/210) respectively, the difference was statistically significant (χ ~ 2 = 234.937, P <0.01 ). The detection rates of the three methods on extrapulmonary tuberculosis were 0 (0/63), 88.88% (56/63) and 0 (0/63), respectively. The positive rates of TSPOT.TB and GeneXpertMTB / RIF were 93.15% (68/73) and 100% (73/73) in antacids positive TB patients, respectively. The positive rates of T-SPOT.TB and Genexpert MTB The positive rates of RIF / RIF were 88.32% (121/137) and 91.24% (125/137). Conclusion: The diagnostic efficiency of T-SPOT.TB and GeneXpertMTB / RIF in diagnosing tuberculosis and tuberculosis is better than that in acid-fast staining. T-SPOT.TB has a higher detection rate in patients with extrapulmonary tuberculosis.