首页 > 过刊浏览>2024年第23卷第2期 >148-154. DOI:10.12138/j.issn.1671-9638.20243433
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优化T-SPOT. TB在区分脊柱结核与其他脊柱感染中的诊断效能
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作者单位:

1.广西医学科学院广西壮族自治区人民医院精准联合检验中心, 广西 南宁 530021;2.中南大学湘雅医院骨科脊柱外科, 湖南 长沙 410008;3.中南大学湘雅医院检验科, 湖南 长沙 410008;4.中南大学湘雅医院国家老年疾病临床医学研究中心, 湖南 长沙 410008

作者简介:

胡小江为共同第一作者。

通讯作者:

高琪乐  E-mail: gaoql@csu.edu.cn

中图分类号:

R529.2

基金项目:

国家自然科学基金项目(82072460、82170901)；湖南省自然科学基金(2020JJ4892、2020JJ4908)


Diagnostic efficacy of optimized T-SPOT. TB in differentiating spinal tuberculosis from other spinal infection
Author:
Affiliation:

1.Precision Joint Laboratory Center, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China;2.Department of Spinal Surgery of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China;3.Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China;4.National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China

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    摘要:

    目的 探讨结核感染T细胞斑点试验(T-SPOT. TB)在脊柱结核(STB)鉴别诊断中的效能, 并通过受试者工作特征(ROC)曲线最佳截断值优化诊断效能。 方法 收集2010年1月—2019年5月某院脊柱感染患者的临床资料, 包括术前T-SPOT. TB检测结果、白细胞计数、C-反应蛋白、血沉、降钙素原和结核抗体等相关数据, 根据诊断标准进行临床诊断, 分析T-SPOT. TB在术前诊断STB与其他脊柱感染中的灵敏度和特异度, 评价优化后的T-SPOT. TB指标的诊断效能。 结果 共纳入132例患者, 其中78例(59.09%)为STB, 54例(40.91%)为非结核脊柱感染。T-SPOT. TB在鉴别诊断STB方面的灵敏度为67.68%, 特异度为66.67%。单因素logistic回归分析显示, 与非结核脊柱感染比较, T-SPOT. TB检测诊断STB的OR值为4.188(95%CI: 1.847~9.974, P＜0.001)。优化T-SPOT. TB评价指标, 通过绘制ROC曲线, 确定ESAT-6、CFP-10、CFP-10+ESAT-6在STB和非结核脊柱感染鉴别诊断中的最佳截断值, 分别为12.5、19.5、36, 曲线下面积(AUC)分别是0.765 6、0.741 5、0.778 6, 均具有较好的诊断性能, 其中以CFP-10+ESAT-6的AUC最高。CFP-10+ESAT-6特异性斑点数在脊柱结核诊断中性能更佳, 其诊断准确度为75.56%, 较优化前T-SPOT. TB的67.42%高。 结论 T-SPOT. TB检测在区分STB与非结核脊柱感染方面显示出较高的诊断效能, T-SPOT. TB检测呈阳性, 尤其是当CFP-10+ESAT-6的斑点数超过36时, 提示脊柱结核的可能性较大。

    Abstract:

    Objective To explore the efficacy of T-cell spot test of tuberculosis infection (T-SPOT. TB) in the differential diagnosis of spinal tuberculosis (STB), and optimize diagnostic efficacy through the optimal cut-off value of receiver operating characteristic (ROC) curve. Methods Clinical data of patients with spinal infection in a hospital from January 2010 to May 2019 were collected, including preoperative T-SPOT. TB test results, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and tuberculosis antibodies, et al. Clinical diagnosis was conducted based on diagnostic criteria. The sensitivity and specificity of T-SPOT. TB in preoperative diagnosis of STB and other spinal infection was analyzed, and the diagnostic efficacy of the optimized T-SPOT. TB indicators was evaluated. Results A total of 132 patients were included in this study, out of whom 78 patients (59.09%) were diagnosed with STB, and 54 (40.91%) were diagnosed with non-tuberculosis (non-TB) spinal infection. The sensitivity and specificity of T-SPOT. TB in differential diagnosis of STB were 67.68% and 66.67%, respectively. Univariate logistic regression analysis showed that compared with non-TB spinal infection, the OR va-lue of T-SPOT. TB test in diagnosing STB was 4.188 (95%CI: 1.847-9.974, P < 0.001). The optimized T-SPOT. TB evaluation index through ROC curve to determine the optimal cut-off values of ESAT-6, CFP-10, and CFP-10+ESAT-6 for differential diagnosis of STB and non-TB spinal infection were 12.5, 19.5, and 36, respectively, and area under curve (AUC) values were 0.765 6, 0.741 5, and 0.778 6, respectively, all with good diagnostic efficacy. CFP-10+ESAT-6 had the highest AUC. CFP-10+ESAT-6 specific spot count had higher efficacy in the diagnosis of STB, with a diagnostic accuracy of 75.56%, higher than 67.42% of pre-optimized T-SPOT. TB. Conclusion T-SPOT. TB test has high diagnostic efficacy in differentiating STB from non-TB spinal infection. Positivity in T-SPOT. TB test, especially with spot count of CFP-10+ESAT-6 over 36, indicates a higher likelihood of STB.

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周莹,胡小江,江仲景,等.优化T-SPOT. TB在区分脊柱结核与其他脊柱感染中的诊断效能[J]. 中国感染控制杂志,2024,23(2):148-154. DOI:10.12138/j. issn.1671-9638.20243433.
Ying ZHOU, Xiao-jiang HU, Zhong-jing JIANG, et al. Diagnostic efficacy of optimized T-SPOT. TB in differentiating spinal tuberculosis from other spinal infection[J]. Chin J Infect Control, 2024,23(2):148-154. DOI:10.12138/j. issn.1671-9638.20243433.

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  • 收稿日期:2023-06-29
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  • 在线发布日期: 2024-04-28
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