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目的 探讨结核抗体检测联合结核感染T细胞斑点试验(T-SPOT.TB)在结核病诊断中的应用价值.方法 选择2016年1月1日至2017年4月12日就诊于北京老年医院的961例结核病患者[结核病组;包括364例菌阳肺结核患者(通过细菌学诊断确诊)和597例菌阴肺结核患者(通过临床进行诊断)]和非结核病的1046例患者(对照组).所有患者同时使用上海奥普生物医药有限公司及新加坡MP生物医学亚太私人有限公司生产的结核抗体金标试剂(分别为TB-DOT、ASSURE TB试剂盒)检测血清中的结核抗体;961例结核病组中的574例及1046例对照组中的664例患者同时使用T-SPOT.TB试剂盒和2种结核抗体金标试剂进行检测.对两组患者采用3种实验室技术进行检测或联合检测(包括串联与并联),对检测结果的敏感度、特异度进行统计学分析.结果 TB-DOT和ASSURE TB检测结核病组和对照组患者的敏感度和特异度分别为52.86％(508/961)、74.95％(784/1046)和45.99％(442/961)、76.00％(795/1046).TB-DOT和ASSURE TB对菌阳和菌阴肺结核患者检测的敏感度分别为64.84％(236/364)、62.09％(226/364)和45.56％(272/597)、36.18％(216/597);菌阳肺结核患者TB-DOT和ASSURE TB检测的敏感度均高于菌阴肺结核患者,差异均有统计学意义(x2值分别为60.99、33.69,P值均＜0.05).结核病组和对照组患者在2种结核抗体金标试剂和T-SPOT.TB试剂盒的串联联合检测中,敏感度为24.04％(138/574),但特异度达到89.91％ (597/664);并联联合检测中,特异度为21.23％(141/664),但敏感度达到89.55％(514/574).结核病组和对照组在ASSURE TB、TB-DOT和T-SPOT.TB 3种检测方法中,均为阳性和均为阴性两种谱型的构成比分别为24.04％(138/574)、10.09％(67/664)和10.45％(60/574)、21.23％(141/664),差异均有统计学意义(x2值分别为43,37和26.32,P值均＜0.05).结论 两种结核抗体与T-SPOT.TB行串联联合检测能够提高检测特异度,并联联合检测能够提高检测敏感度;串联联合检测时,3种检测方法结果均为阳性和均为阴性两种谱型在临床上对结核病血清学诊断具有辅助诊断价值.“,”Objective To explore the value of tuberculosis antibody (TB-Ab) detection and T-SPOT.TB test in TB diagnosis.Methods Between January 1,2016 and April 12,2017 in Beijing Geriatric Hospital,961 TB patients (defined as TB group;including 364 smear positive pulmonary TB cases (bacteriologically diagnosed) and 597 smear negative pulmonary TB cases (clinically diagnosed)) and 1046 non-TB patients (defined as control group) were included in this study.All subjects conducted serological TB-Ab detection by using TB-DOT (Shanghai Upper Bio-Tech Pharma Co.,LTD) and ASSURE TB (MP Biomedicals Asia Pacific Pte Ltd.in Singapore) kits;among them,574 patients in the TB group and 664 patients in the non-TB control group received both T-SPOT.TB test and TB-Ab detections using the two gold standard reagents.The sensitivity and specificity of those three kinds of laboratory detection techniques or joint detection (including tandem detection and parallel detection) were analyzed.Results The sensitivity and specificity of TB-DOT test were 52.86％ (508/961) and 74.95％ (784/1046),and those of ASSURE TB test were 45.99％ (442/961) and 76.00％ (795/1046).The sensitivity of TB-DOT and ASSURE TB were 64.84％ (236/364) and 62.09％ (226/364) for smear positive pulmonary TB patients versus 45.56％ (272/597) and 36.18％ (216/597) for smear negative pulmonary TB patients,which indicated that the sensitivity of TB-DOT and ASSURE TB was higher for smear positive patients compared with smear negative ones;the differences were statistically significant (x2 =60.99 and 33.69,all P＜0.05).Tandem detection of two TB-Ab detections and T SPOT.TB showed a sensitivity of 24.04％ (138/574) and a high specificity of 89.91％ (597/664).The parallel detection had a specificity of 21.23％ (141/664) and a high sensitivity of 89.55％ (514/574).24.04％ (138/574) patients in the TB group and 10.09％ (67/664) patients in the non-TB control group reacted positively in all of the three tests including ASSURE TB,TB-DOT and T-SPOT.TB detection,while 10.45％ (60/574) cases in the TB group and 21.23％ (141/664) cases in the non-TB control group reacted negatively;the differences were statistically significant (x2 =43.37 and 26.32,all P＜0.05).Conclusion Tandem of two TB-Ab detections and T-SPOT.TB test can improve the specificity,whereas parallel detection can improve the sensitivity in TB diagnosis.All positive and all negative profile in all of the three detections has an auxiliary value in serological diagnosis of TB.