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目的 探讨血清结核抗体[相对分子质量为38 000(38 kD)的免疫球蛋白(IgG)]对活动性结核病的诊断价值,并与同期采用外周血行结核感染T淋巴细胞斑点试验(T-SPOT.TB)的检测结果进行比较.方法 回顾性研究2012年1月1日至2014年12月31日期间上海市肺科医院收治入院的活动性结核病患者2146例及非结核病患者1671例.通过受试者工作特征(receiver operating characteristic,ROC)曲线计算并比较血清结核抗体对培养阳性肺结核、临床诊断肺结核和肺外结核的诊断价值;并比较血清结核抗体及T-SPOT.TB检测诊断活动性结核病的敏感度、特异度和ROC曲线下面积(AUC面积),总体评估血清结核抗体对活动性结核病的辅助诊断价值.结果 血清结核抗体对于培养阳性肺结核诊断的敏感度(47.1％,246/522)明显高于临床诊断肺结核(25.9％,388/1499)和肺外结核(24.8％,31/125),差异有统计学意义(x2值分别为81.15和20.53,P值均＜0.001);血清结核抗体对临床诊断肺结核和肺外结核两组之间的敏感度进行比较,差异无统计学意义(x2 =0.07,P=0.790);与外周血T-SPOT.TB检测结果比较,血清结核抗体检测诊断活动性结核病的敏感度(30.6％,657/2146)明显低于T-SPOT.TB检测(76.2％,1635/2146)(x2=799.00,P=0.000);对于活动性结核病的诊断,血清结核抗体检测的AUC面积(0.619;95％CI:0.604～0.635)小于T-SPOT.TB(0.781;95％CI:0.768～0.794)(x2=14.00,P=0.000).血清结核抗体的诊断特异度(93.2％,1557/1671)高于T-SPOT.TB检测(70.1％,1171/1671)(x2=316.00,P=0.000).结论 目前临床使用的血清结核抗体辅助诊断活动性结核病的敏感度尚需提高,应该研发敏感度更高的结核抗体试剂盒,以便能为临床提供更有价值的诊断工具.“,”Objective To investigate the diagnostic value of serum tuberculosis(TB) antibody,which relative molecular mass is 38 000 (38 kD-IgG) for active tuberculosis and compare it with T SPOT.TB.Methods Two thousand one hundred and forty-six patients with active TB and 1671 patients with non-TB pulmonary disease were retrospectively included,analyzed and compared diagnostic value of serum TB antibodies for bacteriological confirmed TB,clinically diagnosed TB and extrapulmonary TB by receiver operating characteristic curve (ROC),compared sensitivity,specificity,and area under the curve (AUC) of T-SPOT.TB and serum TB antibody,finally evaluated auxiliary diagnostic value of serum TB antibody for active TB.Results Our data showed that sensitivity of serum TB antibody for patients with bacteriological confirmed TB (47.1％,246/522) was higher than that for patients with clinically diagnosed (25.9％,388/1499) and extrapulmonary TB (24.8％,31/125) x2 =81.15 and 20.53,respectively;Ps＜0.001.The sensitivity of patients with clinically diagnosed patients and extrapulmonary TB had no statistical difference,x2 =0.07,P =0.790.The sensitivity (30.6 ％,657/2146) of serum TB antibody for active TB was lower than that of T-SPOT.TB (76.2％,1635/2146),x2 =799.00,P=0.000,its AUC (0.619,95％CI:0.604-0.635) was lower than that of T-SPOT.TB (0.781,95 ％ CI:0.768-0.794),x2 =14.00,P =0.000.However,the specificity of serum TB antibody (93.2％,1557/1671) was higher than that of T SPOT.TB (70.1％,1171/1671),x2 =316.00,P=0.000.Conclusion The sensitivity of serum TB antibody applied in clinics needs to get improved,much more sensitive TB antibody diagnostic kit should be developed in order to provide better diagnostic tools for clinics.