目的:观察外周血结核感染T 细胞斑点试验(T-SPOT.TB)对于结核性胸腔积液的诊断应用,并观察其与胸水腺苷脱氨酶活性(ADA)检测联用的价值.方法:选取122例胸腔积液患者,分为结核组和非结核组.入院后行胸腔积液ADA检测、外周血T-SPOT.TB检测及痰结核分枝杆菌培养、痰涂片抗酸染色、组织病理学检查,进行对比分析.结果:结核组与非结核组相比,T-SPOT.TB与ADA阳性率均显著升高,外周血斑点平均数与ADA活性明显升高,差异均具有统计学意义(P＜0.01). A 、B孔斑点平均数AUC＞0.9 ,敏感性98.00%,特异性73.60%;ADA 的AUC为0.846 ,敏感性91.80%,特异性82.60%.结核组中有4例 T-SPOT.TB阴性,其中3例ADA为阳性.非结核组中有12例 T-SPOT.TB阳性,但有10例ADA 为阴性.结论:外周血 T-SPOT.TB对于诊断结核性胸腔积液价值较高,但特异性偏低,与ADA联用时诊断会更为准确.%Objective:To observe the application of T cell spot test (T-SPOT.TB) in the diagnosis of tubercu-lous pleural effusion (T-SPOT.TB),and to observe the value of the combined use of adenosine deaminase activity (ADA) in the diagnosis of tuberculous pleural effusion.Methods:122 patients with pleural effusion were divided in-to tuberculosis group and pulmonary tuberculosis group.After admission,ADA detection of pleural effusion,pe-ripheral blood T-SPOT.TB detection,sputum Mycobacterium tuberculosis,sputum smear anti acid staining and his-topathology were compared and analyzed.Results:The positive rate of T-SPOT.TB and ADA in the tuberculosis group was significantly higher than that in the non tuberculosis group,and the average number of peripheral blood spots and the activity of ADA increased significantly,and the difference was statistically significant (P＜0.01).The average spot size of A and B was AUC＞0.9,sensitivity is 98%,specificity was 73.60%,ADA AUC was 0.846, sensitivity is 91.80%,specificity was 82.60%.There were 4 cases of T-SPOT.TB negative in tuberculosis group, of which 3 cases were positive for ADA.In the non tuberculous group,12 cases were positive for T-SPOT.TB,but 10 cases were negative for ADA.Conclusion:The value of peripheral blood T-SPOT.TB in diagnosis of tuberculous pleural effusion is high,but the specificity is low.When combined with ADA,the diagnosis is more accurate.
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