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目的分析结核感染T细胞免疫斑点试验(T-SPOT. TB)和结核菌素试验在骨关节结核诊断中的应用价值。方法收集2014年1月至2016年8月医院采用手术或保守治疗的骨关节结核患者94例,以及2016年2月至2017年1月骨外科收治的手术治疗的骨关节病患者50例作为研究对象,均进行结核菌素试验与T-SPOT. TB,对比2种方法的诊断效用。结果结核菌素试验诊断敏感性、特异性、阳性预测值、阴性预测值、符合率分别为46.81%、98.00%、97.78%、49.49%、64.58%,TSPOT. TB则为93.62%、100.00%、100.00%、89.29%、95.83%,结核菌素试验敏感性、阴性预测值、符合率低于T-SPOT. TB及2种方法联合检测,差异有统计学意义(P<0.05)。T-SPOT.TB出现6例漏诊,均为早期脊柱结核病,表现为空洞形成,未见脊柱神经缺损。结核菌素试验出现1例误诊,50例漏诊,漏诊者主要病情相对较轻,伴风湿关节病等免疫疾病的患者。结论 TSPOT. TB是诊断骨关节结核病的理想方法,但存在干扰因素,需合理应用,结核菌素试验操作简单,尽管敏感性不足,但在结核病筛查中有一定的价值。
Objective To analyze the value of T-SPOT TB test and tuberculin test in the diagnosis of osteoarticular tuberculosis. Methods A total of 94 patients with osteoarticular tuberculosis treated surgically or conservatively from January 2014 to August 2016 in our hospital and 50 patients with osteoarthropathy surgically treated from January 2016 to January 2017 were selected for the study Subjects, both tuberculin test and T-SPOT. TB, the diagnostic utility of two methods. Results The sensitivity, specificity, positive predictive value and negative predictive value of tuberculin test were 46.81%, 98.00%, 97.78%, 49.49%, 64.58%, respectively. The TSPOT TB was 93.62%, 100.00% 100.00%, 89.29%, 95.83% respectively. The sensitivity and the negative predictive value of tuberculin test were lower than that of T-SPOT. TB and the two methods were significantly different (P <0.05). T-SPOT.TB 6 cases of missed diagnosis, are early spinal tuberculosis, the performance of the formation of empty, no spinal nerve defect. Tuberculin test showed a case of misdiagnosis, 50 cases of missed diagnosis, the main condition of the missed diagnosis is relatively mild, patients with rheumatoid arthritis and other immune diseases. Conclusion TSPOT TB is an ideal method for the diagnosis of tuberculosis of the bone and joint, but there are interference factors to be applied reasonably. The tuberculin test is easy to operate and has some value in the screening of tuberculosis despite the lack of sensitivity.