| Objective: Comparing with peripheral blood,this article evaluated the accuracy of interferon-gamma enzyme-linked immunospot assays(T-SPOT.TB)on serous effusion for diagnosing tuberculous serositis in children,which included pleural effusion,peritoneal effusion and pericardial effusion.Methods: 48 cases were enrolled prospectively in the study admitted to Children’s Hospital of Chongqing Medical University from May 2018 to November 2019.Both serous effusion and peripheral blood were collected simultaneously to obtain serous effusion mononuclear cells(SEMCs)and peripheral blood mononuclear cells(PBMCs)and accomplish T-SPOT.TB test.According to the final clinical diagnosis,Diagnostic accuracy of serous effusion and peripheral blood were compared with the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV).Results: Among 48 cases with suspected tuberculous serositis,22/48 cases(45.8%)were clinically or etiologically diagnosed as tuberculous serositis,22/48 cases(45.8%)were diagnosed as non-tuberculous serositis,2/48 cases(4.2%)with indeterminate result of T-SPOT.TB and 2/48 cases(4.2%)with indeterminate diagnosis were not included in the final analysis.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(LR+)and negative likelihood ratio(LR-)of SEMCs compared with PBMCs for diagnosing tuberculous serositis were 95.5%(95%confidence-interval [CI]:75.1%-99.8%)vs.90.9%(95%CI:69.4%-98.4%),86.4%(95%CI:64%-96.4%)vs.90.9%(95%CI:69.4%-98.4%),87.5%(95%CI:66.5%-96.7%)vs.90.9%(95%CI:69.4%-98.4%),95%(95%CI:73.1%-99.7%)vs90.9%(95%CI:69.4%-98.4%),7.02(95%CI:2.44-20.11)vs.9.99(95%CI:2.65-37.73),0.05(95%CI:0.01-0.36)vs0.1(95%CI:0.03-0.38),respectively,which had no statistically significant difference(P > 0.05).There was excellent consistency between T-SPOT.TB on SEMCs and PBMCs with the Kappa number of 90.9%(95%CI:0.786-1.032,P=0.001<0.05).For tuberculous serositis group,the frequency of spot forming cells(SFCs)of SEMCs was 1960/5 10^5(interquartile range,IQR: 262.5/5×10^5-2335/5×10^5),which were significantly higher than those of PBMCs(Z=-3.667,P<0.05)and was about 4.5 times(IQR,2.3–8.6)that of PBMCs.The receiver operating characteristic curve(ROC)was used to analyze the frequency of SFCs and obtain the optimal cut-off value which was 15 SFCs per 5×10^5 mononuclear cells for T-SPOT.TB on SEMCs,and the area under the curve(AUC)was 0.932.The sensitivity and specificity were 95.45% and 81.82%,respectively,and the Youden index was 0.7727.The sensitivity and specificity of parallel test were 95.5% and 86.4%,and 90.9% and 90.9% for serial test.Conclusion: In areas with high TB burden,compared with peripheral blood,there is no significant difference in the diagnostic efficiency of T-SPOT.TB in serous effusion,which could be an accurate diagnostic method for tuberculous serositis in children.15 SFCs per 5×10^5 SEMCs might be the optimal cut-off value for the diagnosis of tuberculous serositis. |
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