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目的评价酶联免疫斑点试验(ELISPOT)在糖尿病并发肺结核诊断中的应用价值。方法选择广州市胸科医院糖尿病并发可疑肺结核病人共132例,对其进行PPD试验和ELISPOT试验。根据临床诊断分为糖尿病合并菌阳肺结核组、菌阴肺结核组、非结核、合并结核(菌阳组+菌阴组)四组,分别比较ELISPOT试验和PPD试验在这四组人群中的阳性率差异,并计算ELISPOT试验和PPD试验在糖尿病合并菌阳、菌阴、非肺结核、合并结核(菌阳+菌阴组)人群中的敏感性、特异性、阳性预测值和阴性预测值,并且分析血糖控制情况对实验结果的影响。结果只有在糖尿病合并非结核人群中,ELISPOT试验和PPD试验的阳性率有显著性差异,PPD试验的假阳性率较高。在其它三组人群中,两个试验的阳性率无显著性差异。PPD试验在糖尿病合并菌阳、菌阴组中的特异性较低(<40%),而ELISPOT试验在每组人群中都保持了较高的敏感性和特异性(>80%)。ELISPOT试验对糖尿病合并结核(菌阳+菌阴)诊断的敏感性、特异性、阳性预测值和阴性预测值分别为83.6%、98.0%、87.5%和42.4%。血糖控制较差的人和血糖控制较好的人群比较,ELISPOT试验和PPD试验诊断的敏感性、特异性、阳性预测值和阴性预测值并没有显著性差异。结论 ELISPOT试验是糖尿病并发肺结核早期诊断的快速有效的方法。
Objective To evaluate the diagnostic value of ELISPOT in the diagnosis of pulmonary tuberculosis complicated with diabetes. Methods A total of 132 patients with suspected pulmonary tuberculosis in the Chest Hospital of Guangzhou City were enrolled in this study. PPD test and ELISPOT test were performed on them. According to the clinical diagnosis, they were divided into four groups: diabetes mellitus combined positive pulmonary tuberculosis group, bacteria negative pulmonary tuberculosis group, non-tuberculosis combined tuberculosis group (bacteria positive group + bacteria negative group). The positive rates of ELISPOT test and PPD test in these four groups were compared , And calculated the sensitivity, specificity, positive predictive value and negative predictive value of ELISPOT test and PPD test in diabetic patients with positive bacteria, negative bacteria, non-pulmonary tuberculosis, combined tuberculosis (bacteria positive + bacteria negative group), and analyzed The impact of glycemic control on experimental results. Results Only in the non-tuberculosis patients with diabetes mellitus, the positive rate of ELISPOT test and PPD test were significantly different, and the false positive rate of PPD test was higher. In the other three groups, there was no significant difference between the two tests. The PPD test was less specific (<40%) in the diabetic and bacteriostatic groups, whereas the ELISPOT test maintained a high sensitivity and specificity (> 80%) in each cohort. The sensitivity, specificity, positive predictive value and negative predictive value of ELISPOT in the diagnosis of diabetes combined with tuberculosis (bacilli + fungus yin) were 83.6%, 98.0%, 87.5% and 42.4%, respectively. There was no significant difference in the sensitivity, specificity, positive predictive value and negative predictive value of ELISPOT test and PPD test in people with poor glycemic control and those with good glycemic control. Conclusion The ELISPOT test is a rapid and effective method for the early diagnosis of pulmonary tuberculosis.