| Objectives:1 Evaluate the value of T-SPOT.TB, tuberculosis antibody(TB-Ab)and Acid fast bacilli smear in the diagnosis of active tuberculosis.2 Compare T-SPOT.TB and tuberculin skin test(TST) in the diagnosis of the subjects with active TB exposure history and non-active tuberculosis exposure history.3 Compare the spots of the latent tuberculosis and active tuberculosis.4 Compared with pleural effusion ADA, whether T-SPOT.TB has more value in the diagnosis tuberculous pleurisy.Methods:1 Total of 294 inpatients who was suspected of tuberculosis(TB) during the period from March 2011 to December 2014 at the First Hospital of Qinhuangdao were enrolled. T-SPOT.TB and TB-Ab in blood, and sputum Acid fast bacilli stain were performed to each case. According to the diagnosis standard,294 cases were devided into active tuberculosis(99 cases) and non-tuberculosis group(195 cases).2 104 cases of patients with pleural effusion were enrolled in the trial. T-SPOT.TB in peripheral blood and pleural effusion and ADA in blood were detected. The patients were devided into 2 groups: tuberculous pleural effusion group and non-tuberculous pleural effusion one.Results:1 The sensitivity and specificity of the T-SPOT.TB for the diagnosis of active tuberculosis were 90.91%, 87.69%. The sensitivity and specificity of the TB-Ab for the diagnosis of active tuberculous were 39.39%, 78.69%. And the Acid fast bacilli stain were 25.25%, 100%.2 The specificity of T-SPOT.TB was higher than TST in the subjects without active tuberculosis exposure history( P<0.01).3 In the active tuberculosis group, the x ±s of T-SPOT.TB spot forming cells(SCFs) was 64.22±50.38. In the latent tuberculosis group, the x ±s of T-SPOT.TB was 16.08±10.49. There was a significant difference between the spots of active tuberculosis and latent tuberculosis(P=0.000). The study indicated that when the cut-off value is defined as 20.5, sensitivity will be 81.8%, and specificity can increase to 96.2%.4 The sensitivity of the T-SPOT.TB in peripheral blood and pleural effusion for the diagnosis of tuberculous pleurisy were 81.8%、95.4.%. The specificity of the T-SPOT.TB were 66.7%, 50.0%. The sensitivity of ADA for the diagnosis of tuberculous pleurisy was 54.5%, the specificity of ADA was 71.7%. 2 TB SFCS in peripheral blood and pleural fluid of tuberculosis group were higher than non-tuberculosis group(P=0.000). In tuberculosis group, 2 antigens SFCs in pleural fluid were higher than peripheral blood(P=0.000). ROC curve was made to evaluate the cut-off value of T-SPOT.TB in Pleural effusion. The study indicated that when the cut-off value is defined as 88, its sensitivity will be 84.1% and specificity can be increased to 95.0%.Conclusions:1 Compared with the three methods of T-SPOT.TB, TB-Ab, Acid fast bacilli stain in diagnosis of active tuberculosis, the sensitivity and specificity of T-SPOT.TB are higher than TB-Ab, the sensitivity of T-SPOT.TB is relatively higher than Acid fast bacilli smear, but the specificity of the T-SPOT.TB is lower than Acid fast bacilli stain.2 In high TB-burden countries,The specificity of T-SPOT.TB is higher than TST in the subjects without active tuberculosis exposure history.3 There is a significant difference between the spots of active tuberculosis and latent tuberculosis( P=0.000). However because of the high overlapping rate between the two group, it is still hard to say that T-SPOT.TB can be used to distinguish active tuberculosis and latent tuberculosis.4 T-SPOT.TB in pleural effusionhas a very high sensitivity and specificity for diagnosis of tuberculous pleurisy. The positive standard of T-SPOT.TB in peripheral blood may not be applicable to the pleural effusion T-SPOT.TB. When the positive standard of the pleural effusion T-SPOT.TB changes, the sensitivity and specificity are improved obviously. T-SPOT.TB is an assistant diagnostic method of tuberculous pleurisy, deserving more studies and clinical extention. |
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