摘要
目的探讨T-SPOT.TB中结核特异抗原ESAT-6、CFP-10以及两者的联合检测在诊断结核病中的临床意义以及与年龄的关系。方法通过对2015年6月—2017年7月在本院疑诊为结核病的2088例住院成年(≥18岁)患者进行回顾性分析,根据出院最终诊断分为结核病组、非结核患者组。所有患者均保留有T-SPOT.TB数据,根据T-SPOT.TB结果对T细胞斑点数进行比较分析。(1)将两项指标单一和联合诊断结核病的敏感度、特异性、阳性预测值(PPV)、阴性预测值(NPV)进行χ2检验和ROC曲线分析。(2)根据年龄分组,探讨不同年龄阶段T-SPOT对结核病的诊断价值。结果 (1) ESAT-6诊断结核病的敏感度为75.1%、特异度为79.8%、PPV为49.1%、NPV为92.5%,ROC曲线下面积为0.828(95%CI0.804～0.851),最佳阈值为4.5。CFP-10诊断结核病的敏感度为64.9%、特异度为84.5%、PPV为52.1%、NPV为90.3%,ROC曲线下面积为0.810(95%CI 0.785～0.834),最佳阈值为3.5。ESAT-6联合CFP-10(T-SPOT)诊断结核病的敏感度为81.2%、特异度为77.1%、PPV为48%、NPV为94%,ROC曲线下面积为0.840(95%CI 0.818～0.863),最佳阈值为6。(2)老年组、中青年组T-SPOT敏感度分别为76.51%和84.1%,特异度分别为67.55%和82.13%。结论 (1) ESAT-6抗原的敏感度优于CFP-10抗原,特异度低于CFP-10。(2) ESAT-6、CFP-10两者检测各有优势,具有互补作用,两者的联合检测(T-SPOT),即ESAT-6/CFP-10混合抗原多肽可大大提高检测的灵敏度,对诊断结核病更有意义。(3) T-SPOT的最佳截断点为6时,对结核病的诊断价值最佳。(4)对于T-SPOT. TB检测的敏感度、特异度,在老年组均低于中青年组患者,两者差异有统计学意义(P<0.05)。T-SPOT.TB检测的敏感度、特异度与年龄呈负相关关系(r=-0.439、-0.241,P<0.05)。
Objective To evaluate the clinical significance of tuberculosis specific antigens ESAT-6 and CFP-10 and their combined detection in T-SPOT.TB in the diagnosis of tuberculosis and the relationship with age.Methods Retrospective analysis was conducted on 2088 hospitalized adults( ≥ 18 years old) who were suspected of TB and hospitalized in the first affiliated hospital of Anhui Medical University from June 2015 to July2017.According to the final diagnosis when they leave the hospital,they were divided into tuberculosis group and non-tuberculosis group.T-SPOT.TB data all patients were retained,and the number of T cell spots was compared based on the T-SPOT.TB results.Perform χ2 test and ROC curve analysis on the sensitivity,specificity,positive predictive value( PPV),and negative predictive value( NPV) of the two indicators for single and combined diagnosis of tuberculosis.According to age grouping,explore the diagnostic value of T-SPOT for tuberculosis at different ages.Results The sensitivity of ESAT-6 for diagnosis of tuberculosis was 75.1%,specificity was 79.8%,PPV was 49.1%,NPV was 92.5%,area under ROC curve was 0.828( 95% CI 0.804 ~ 0.851),and optimal threshold was 4.5.The sensitivity of CFP-10 for diagnosis of tuberculosis was 64.9%,specificity was 84.5%,PPV was 52.1%,NPV was 90.3%,area under ROC curve was 0.810( 95% CI 0.785 ~ 0.834),and optimal threshold was 3.5.The sensitivity of ESAT-6 combined with CFP-10( T-SPOT) for diagnosis of tuberculosis was81.2%,specificity was 77.1%,PPV was 48%,NPV was 94%,and the area under the ROC curve was 0.840( 95% CI 0.818~0.863).The optimal threshold was 6.2.The T-SPOT sensitivity of the elderly group and the youth group were 76.51% and 84.1%,and the specificities were 67.5% and 82.13%,respectively.Conclusions The sensitivity of ESAT-6 antigen is better than that of CFP-10 antigen,and the specificity is lower than that of CFP-10.ESAT-6 and CFP-10 have their own advantages and complement with each other,the ESAT-6/CFP-10 mixed antigen polypeptide detection could greatly improve the sensitivity of detection and is more meaningful for diagnosing tuberculosis.When the optimal cut-off point of T-SPOT is 6,the diagnostic value for tuberculosis is the best.For T-SPOT.TB,the sensitivity and specificity of TB detection were lower in the elderly group than in the youth group,and the difference was statistically significant( P<0.05).The sensitivity and specificity had negative correlations with age( r =-0.439,-0.241,P<0.05).
作者
华国新
叶英
HUA Guo-xin(The first affiliated hospital of Anhui Medical University,Hefei,Anhui,230032,China)
出处
《齐齐哈尔医学院学报》
2018年第19期2236-2240,共5页
Journal of Qiqihar Medical University
