Application Of T Cell Spot Test In Diagnosis Of Osteoarticular Tuberculosis

Background Osteoarticular tuberculosis is a bone and joint disease caused by Mycobacterium tuberculosis invading bone,joint,synovial membrane and spine.It may cause abscesses and ulcers in the vicinity of lesions.Osteoarticular tuberculosis incidence of occult,atypical early symptoms,imaging diagnosis is unclear,resulting in misdiagnosis and delayed treatment in patients with bone and joint deformities,even lead to some patients with spinal tuberculosis kyphosis or nerve compression resulting in paraplegia,bring irreparable loss to the patient.So early diagnosis and early treatment are very important for the patients with osteoarticular tuberculosis.Tuberculosis T lymphocyte(T-SPOT.TB)spot test is aγ-interferon release test,is the use of in vitro tuberculosis specific antigen stimulation specific effector T lymphocytes to produce γ-interferon,detection ofγ-interferon by double antibody sandwich method in order to determine whether there is an interferon for tuberculosis infection.This method is of high value in the diagnosis of tuberculosis infection.There are many studies on the diagnostic value of T-SPOT.TB in tuberculosis and extrapulmonary tuberculosis,and there are few studies on the application value in the osteoarticular tuberculosis.Objective The purpose of this study is to explore the diagnostic value of T-SPOT.TB in osteoarticular tuberculosis,and to study its sensitivity and specificity in the diagnosis of osteoarticular tuberculosis,and to compare with other diagnostic methods of tuberculosis.Method Using the retrospective analysis method,the clinical data were collected in Yichun People’s Hospital from January 2015 to October 2017.During this period of time,68 patients with bone and joint tuberculosis patients,and 80 cases of non tuberculosis patients with osteoarthritis were admitted in our study,and 60 healthy subjects were chose as control group.The clinical data,T-SPOT.TB,ESR,and other indicators oftuberculosis antibody were collected and compared to test the diagnostic performance of several methods.Through comparative analysis,the diagnostic value of T-SPOT.TB for tuberculosis of bone and joint was studied.Result1.There were no significant differences in gender and age between 68 patients with osteoarticular tuberculosis,80 patients with non tuberculous osteoarthritis and 60 healthy controls(P>0.05).2.There was a significant difference in total lymphocyte count,CRP and ALP in non tuberculous osteoarthritis group,osteoarticular tuberculosis group and healthy control group(P<0.05).There was a significant difference in total lymphocyte count and Hb between osteoarticular tuberculosis group and non tuberculous osteoarthritis group(P<0.05).3.The positive rates of antigen A(ESAT-6)and antigen B(CFP-10)in osteoarticular tuberculosis group were 75.8% and 72.4%,respectively,and the number of positive spots of antigen A and antigen B were all significantly higher than those in healthy control group and non tuberculous osteoarthritis group,the difference was statistically significant.4.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of T-SPOT.TB were 82.7%,85.2%,88.8%,82.7%,85.7%,which were significantly higher than those of tuberculosis antibody and ESR.Combined antigen A and antigen B detection could significantly improve the accuracy of diagnosis.5.Through the analysis of ROC curve,ROC curve area of T-SPOT.TB antigen A and B antigen of osteoarticular tuberculosis diagnosed by(AUC)0.869(95%CI =0.806 ~ 0.933)and 0.881(95%CI = 0.819 ~ 0.944),the Cutoff value is 5.5 and 4.5,the sensitivity is 79.4% and 85.0%,the specificity was 88.7% and 85.3%.Conclusion T-SPOT.TB is of high value in the diagnosis of tuberculosis infection of bone and joint.