栏目: 临床医学

摘要
• 摘要:   目的  评价T细胞酶联免疫斑点（T-cells enzyme linked immunospot, TSPOT.TB）试验在儿童结核病中的诊断价值。  方法  收集2017年1~12月在重庆医科大学附属儿童医院住院并完善TSPOT.TB试验的2 348例患儿，结合患儿的病例资料，分析TSPOT.TB试验在儿童结核病中的诊断价值。  结果  本研究中TSPOT.TB试验诊断儿童结核病的敏感度为84.0%，特异度为99.1%，阳性预测值为93.1%，阴性预测值为97.8%。TSPOT.TB试验受试者工作特征（ROC）曲线下面积（area under the curve，AUC）为：A抗原的AUC值为0.893（P<0.05），B抗原AUC值为0.883（P<0.05）。当A抗原或B抗原的斑孔数≤50时，随着TSPOT.TB试验斑孔数的增加，TSPOT.TB试验诊断儿童结核病的敏感度亦增加，但无明确线性关系；当A抗原或B抗原的斑孔数>50时，TSPOT.TB试验诊断儿童结核病具有高度的敏感度。TSPOT.TB真阳性病例组中，肺结核组的敏感度高于肺外结核组（P<0.05）。不同年龄结核病患儿中，随着患儿年龄的增长，TSPOT.TB试验的敏感度亦随之升高。  结论  TSPOT.TB试验在儿童结核病中有较高的诊断价值，可以快速辅助诊断儿童结核病。

  关键词:
  • T细胞酶联免疫斑点试验 / 
  • 结核病 / 
  • 儿童 / 
  • ROC曲线 
  Abstract:   Objective  To evaluate the diagnostic value of T-cells enzyme linked immunospot (TSPOT.TB) in the children with tuberculosis.  Methods  The clinical data was retrieved from 2 348 children who underwent TSPOT.TB test in the Children's Hospital of Chongqing Medical University from January 2017 to December 2017. The diagnostic value of TSPOT.TB in the children with tuberculosis was analyzed.  Results  In the diagnosis of children tuberculosis, the sensitivity of TSPOT.TB was 84.0%, the specificity was 99.1%, the positive predictive value was 93.1%, and the negative predictive value was 97.8%. To the area under receiver operating characteristic (ROC) curve of TSPOT.TB, the area under the curve (AUC) value of A antigen and B antigen were 0.893 and 0.883, respectively (P<0.05). When the number of A or B antigens was less than 50, the sensitivity was increased with the increase of puncture number, but there was no clear linear relationship. TSPOT.TB had a highly sensitivity to childhood tuberculosis when the number of A or B antigens was greater than 50. In the true positive groups of TSPOT.TB, the sensitivity of pulmonary tuberculosis group was significantly higher than that of extrapulmonary tuberculosis group (P<0.05). In addition, the sensitivity to TSPOT.TB increased with age.  Conclusion  TSPOT.TB has high diagnostic value in the children with tuberculosis, which can rapidly assist to diagnose pediatric tuberculosis.

  Key words:
  • TSPOT.TB / 
  • Tuberculosis / 
  • Children / 
  • ROC curve 
HTML全文
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  图  1  TSPOT.TB试验ROC曲线

  Figure  1.  The ROC curve of TSPOT.TB test

  下载: 全尺寸图片 幻灯片
  

  图  2  TSPOT.TB试验斑孔数与其敏感度的关系

  Figure  2.  The relationship between the number of punctures and their sensitivity in TSPOT.TB test

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  表  1  真阳性及假阴性病例的TSPOT.TB试验结果

  Table  1.   The results of TSPOT.TB for true positive and false negative cases

  Clinical diagnosis	n	TSPOT.TB		Sensitivity
  		Positive/ case	Negative/ case
  Latent tuberculosis infection	8	8	0	100.0%
  Only pulmonary tuberculosis	122	110	12	90.2%
  Multivisceral tuberculosis including pulmonary tuberculosis	130	116	14	89.2%
  Intestinal tuberculosis	2	1	1	50.0%
  Tuberculosis meningitis	2	1	1	50.0%
  Nodal tuberculosis	18	6	12	33.3%
  Arthrotuberculosis	4	0	4	0%
  Urological tuberculosis	2	0	2	0%
  Total	288	242	46	84.0%

  下载: 导出CSV

  表  2  TSPOT.TB试验假阳性结果的斑孔数

  Table  2.   The number of false positive results of TSPOT.TB test

  Diagnosis	Serial number	The number of TSPOT.TB
  		ESAT-6	CFP-10
  Pneumonia	1	16	37
  	2	16	18
  	3	8	5
  	4	20	10
  	5	12	11
  	6	40	20
  	7	7	7
  	8	8	8
  	9	16	12
  	10	10	13
  Juvenile idiopathic arthritis	1	8	0
  	2	8	10
  	3	4	14
  Acute disseminated encephalomyelitis	1	7	3
  Cryptococcal encephalitis	1	7	0
  Pulmonary vascular malformation	1	7	3
  Disseminated BCG combined with chronic granulomatous disease	1	8	5
  Burkitt lymphoma	1	150	150

  下载: 导出CSV

  表  3  不同年龄组间结核病患儿的TSPOT.TB试验敏感度的比较

  Table  3.   The sensitivity of TSPOT.TB test in different age groups

  Group	n	TSPOT.TB		Sensitivity
  		Positive/case	Negative/case
  0 yr.-	34	24	10	70.6%*
  1 yr.-	20	16	4	80.0%
  3 yr.-	64	55	9	85.9%
  7 yr.-	114	97	17	85.1%
  13-<18 yr.	56	50	6	89.3%
  Total	288	242	46	84.0%
  *P<0.05, vs. 13-<18 yr. group

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