A comparative study of the diagnostic value of T-SPOT.TB in cerebrospinal fluid and peripheral blood for tuberculous meningitis
SONG Tao1 FU Hongyi1 LI Lijuan2
1.Department of TB Medicine, Hebei Chest Hospital, Hebei Province, Shijiazhuang 050041, China;
2.the First Department of Cadre's Ward, Bethune International Peace Hospital of Chinese, Hebei Province, Shijiazhuang 050004, China
Abstract：Objective To evaluate the diagnostic value of T-SPOT.TB in cerebrospinal fluid for tuberculous meningitis. Methods A total of 147 inpatients of suspected tuberculous meningitis in the Department of TB Medicine of Hebei Chest Hospital from January 2012 to June 2016 were selected. Based on final diagnosis, 133 patients were divided into two groups: tuberculous meningitis group and non tuberculous meningitis group. The positive and the negative rates of T-SPOT.TB in cerebrospinal fluid and peripheral blood were compared. Results Among the patients, there were 76 cases of diagnosed tuberculous meningitis, and 57 cases of non tuberculous meningitis. The sensitivity of T-SPOT.TB in peripheral blood was 77.63%, compared with 63.16% of T-SPOT.TB in cerebrospinal fluid, there was no statistically significant difference (P > 0.05). The specificity of T-SPOT.TB in cerebrospinal fluid was 98.25%, significantly higher than 84.21% of T-SPOT.TB in peripheral blood, the difference was statistically significant (P < 0.05). The positive predictive value of T-SPOT.TB in cerebrospinal fluid was 97.96%, higher than 86.76% of T-SPOT.TB in peripheral blood, the difference was statistically significant (P < 0.05). The negative predictive value of T-SPOT.TB in peripheral blood was 73.85%, compared with 66.67% of T-SPOT.TB in cerebrospinal fluid, there was no statistically significant difference between the results (P > 0.05). Taking 96 SFCs/106PEMC as the cut-off value, the sensitivity, specificity, PPV, NPV and AUROC of T-SPOT.TB in cerebrospinal fluid in diagnosis of tuberculous meningitis were 90.79%, 98.25%, 98.57%, 88.89% and 0.993 (95%CI: 0.982-1.000), respectively. Conclusion Compared with T-SPOT.TB in peripheral blood, the T-SPOT.TB in cerebrospinal fluid can significantly improve the specificity and PPV, and accurate diagnosis level of tuberculous meningitis.
宋韬1 付洪义1 李莉娟2. 脑脊液与外周血T-SPOT.TB对结核性脑膜炎诊断价值的比较[J]. 中国医药导报, 2018, 15(16): 50-54.
SONG Tao1 FU Hongyi1 LI Lijuan2. A comparative study of the diagnostic value of T-SPOT.TB in cerebrospinal fluid and peripheral blood for tuberculous meningitis. 中国医药导报, 2018, 15(16): 50-54.
[1] 马玙，朱莉贞，潘毓萱.结核病[M].北京：人民卫生出版社，2006：254.
[2] 唐神结，高文.临床结核病学[M].北京：人民卫生出版社，2011：366.
[3] 史玲莉.免疫学方法诊断结核病的研究进展[J].河北医科大学学报，2013，34（11）：1475-1480.
[4] Menzies D，Pai M，Comstock G. Meta-analysis：new tests for the diagnosis of latent tuberculosis infection：areas of uncertainty and recommendations for research [J]. Ann Intern Med，2007，146（5）：340-354.
[5] Van der Weert EM，Hartgers HM，Schaaf HS，et al. Comparison of diagnostic criteria of tuberculous meningitis in human immunodeficiency virus-infected and uninfected children [J]. Pediatr Infect Dis J，2006，25（1）：65-69.
[6] Thwaites GE，Duc Bang N，Huy Dung N，et al. The influence of HIV infection on clinical presentation，response to treatment，and outcome in adults with Tuberculous meningitis [J]. J Infect Dis，2005，192（12）：2134-2141.
[7] Garg RK. Tuberculosis of the central nervous system [J]. Postgrad Med J Mar，1999，75（881）：133-140.
[8] Bidstrup C，Andersen PH，Skinhoj P，et al. Tuberculous meningitis in a country with a low incidence of tuberculous：still a serious disease and a diagnostic challenge [J]. Acand J Infenct Dis，2002，34（11）：811-814.
[9] Pai M，Flores LL，Pai N，et al. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis：a systematic review and meta-analysis [J]. Lancet Infect Dis Oct，2003，3（10）：633-643.
[10] 刁珊珊，杜建红，翟北平，等.结核性脑膜炎的诊断和治疗[J].现代生物医学进展，2014，14（33）：6592-6596.
[11] 王丽，张元刚，胡亚卓，等.CT、MRI在结核性脑膜炎诊断中的应用[J].中外医学研究，2016，14（31）：60-62.
[12] 邹月丽.结核性脑膜炎早期诊断的相关性研究[D].石家庄：河北医科大学，2015.
[13] 秦珍，许莉，迟凤丽，等.结核性脑膜炎的诊断和治疗进展[J].中国现代药物应用，2016，10（18）：286-287.
[14] 中华医学会结核病分会，《中华结核和呼吸杂志》编辑委员会.T-SPOT.TB在中国应用的建议[J].中华结核和呼吸杂志，2014，37（10）：744-747.
[15] 刘菲，张霞，杜凤娇，等.T-SPOT.TB检测胸腔积液对诊断结核性胸膜炎的初步探讨[J].中华结核和呼吸杂志，2014，37（5）：323-327.
[16] Kim SH，Chu K，Choi SJ，et al. Diagnosis of central nervous system tuberculousis by T-cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells [J]. Clin Vaccine Immunol，2008，15（9）：1356-1362.
[17] Thomas MM，Hinks TS，Raghuraman S，et al. Rapid diagnosis of Mycobacterium tuberculousis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells [J]. Int J Tuberc Lung Dis，2008，12（6）：651-657.
[18] 李雪莲，陈红梅，张立群，等.脑脊液γ-干扰素检测对结核性脑膜炎的诊断价值[J].中国医刊，2016，51（11）：35-38.
[19] 程利.T-SPOT.TB检验在活动性肺结核患者中的临床意义[J].中国医药科学，2016，6（1）：220-222.
[20] 郑臻，黄海，邹毅，等.抗结核抗体与结核感染T细胞斑点试验在结核病诊断中的应用[J].中华医院感染学杂志，2016，26（10）：2232-2234.
2018, Vol. 15 
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