摘要
目的观察涂阴肺结核患者外周血单核细胞和淋巴细胞的表达特点,探讨其与结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)联合检测在涂阴肺结核诊断与鉴别诊断中的临床价值,为其早期诊断提供新指标。方法以2018年1月1日至2018年12月31日在首都医科大学附属北京胸科医院住院的134例涂阴肺结核患者、56例肺癌患者和95例肺炎患者作为研究对象,收集并回顾性分析3组患者外周血单核细胞、淋巴细胞、单核细胞与淋巴细胞(ML)比值、T-SPOT.TB及相关临床资料。选择在3组患者间差异有统计学意义的指标,采用敏感度、特异度、误诊率、漏诊率和诊断正确率,评估其单独或联合T-SPOT.TB在涂阴肺结核与肺癌、肺炎诊断与鉴别诊断中的临床价值。结果(1)涂阴肺结核组单核细胞百分比[(8.96±2.46)%]、ML绝对值比值(0.36±0.19)均高于肺癌组[分别为(7.06±1.34)%、0.30±0.13]和肺炎组[分别为(8.17±2.13)%、0.31±0.18],而其白细胞总数[(5.86±1.75)×10^(9)/L]低于肺癌组[(6.88±1.76)×10^(9)/L],淋巴细胞绝对值[(1.57±0.54)×10^(9)/L]低于肺炎组[(1.87±0.67)×10^(9)/L],差异均有统计学意义(P值均<0.05)。(2)就涂阴肺结核与肺癌鉴别诊断而言,单核细胞百分比的特异度(87.50%)较高,误诊率(12.50%)较低,优于ML绝对值比值(分别为17.86%、82.14%)和T-SPOT.TB(67.86%、32.14%)。ML绝对值比值的敏感度(88.81%)与T-SPOT.TB(87.31%)相接近。就涂阴肺结核与肺炎鉴别诊断而言,ML绝对值比值的敏感度(88.81%)高于单核细胞百分比(66.42%),与T-SPOT.TB(87.31%)相接近,但其特异度(28.42%)低于T-SPOT.TB(63.16%)和单核细胞百分比(56.84%)。(3)单核细胞百分比和ML绝对值比值分别联合T-SPOT.TB(并联)辅助诊断涂阴肺结核的的敏感度分别为97.01%和99.25%,漏诊率分别为2.99%和0.75%。在涂阴肺结核与肺癌的鉴别诊断中,单核细胞百分比联合T-SPOT.TB(串联)的特异度为94.64%,误诊率为5.36%。在涂阴肺结核和肺炎鉴别诊断中,单核细胞百分比联合T-SPOT.TB(串联)和ML绝对值比值联合T-SPOT.TB(串联)的特异度分别为82.11%和70.53%,误诊率分别为17.89%和29.47%。结论单核细胞百分比和ML绝对值比值与T-SPOT.TB联合检测分别在涂阴肺结核与肺癌、肺炎的鉴别诊断中具有潜在的临床价值,且其测定简便易行、价格低廉,可以作为涂阴肺结核辅助诊断指标,根据临床需要选择。
Objective To observe the expression characteristics of peripheral blood monocytes and lymphocytes in patients with smear negative pulmonary tuberculosis(SNPT)and to explore the clinical value of the combined detection with T-cell spot test of tuberculosis(T-SPOT.TB)in the diagnosis and differential diagnosis of SNPT,so as to provide new indicators for its early diagnosis.Methods A total of 134 patients with SNPT,56 patients with lung cancer and 95 patients with pneumonia hospitalized in Beijing Chest Hospital,Capital Medical University from January 2018 to December 2018 were enrolled in the study.The data of monocytes,lymphocytes and the ratio of monocytes to lymphocytes(ML ratio)in peripheral blood and T-SPOT.TB and related clinical information in three groups were collected and retrospectively analyzed.We selected the statistically different indicators of three groups and used sensitivity,specificity,misdiagnosis rate,missed diagnosis rate and diagnostic accuracy to evaluate the diagnosis and differential diagnosis of SNPT,lung cancer,and pneumonia by alone or in combination with T-SPOT.TB.Results(1)The percentage of M[(8.96±2.46)%]and ML ratio(0.36±0.19)in the SNPT group were significantly higher than those in the lung cancer group[(7.06±1.34)% and 0.30±0.13,respectively]and pneumonia group[(8.17±2.13)%and 0.31±0.18,respectively],while the number of white blood cells[(5.86±1.75)×10^(9)/L]was significantly lower than that in the lung cancer group[(6.88±1.76)×10^(9)/L]and the value of L[(1.57±0.54)×10^(9)/L]was significantly lower than that in the pneumonia group[(1.87±0.67)×10^(9)/L](P<0.05).(2)In the differential diagnosis of SNPT and lung cancer,the specificity(87.50%)and misdiagnosis rate(12.50%)of the percentage of M were better than ML ratio(17.86% and 82.14%,respectively)and T-SPOT.TB(67.86% and 32.14%,respectively).The sensitivity of ML ratio(88.81%)was close to that of T-SPOT.TB(87.31%).As for the differential diagnosis of SNPT and pneumonia,the sensitivity of ML ratio(88.81%)was higher than that of the percentage of M(66.42%),which was close to that of T-SPOT.TB(87.31%),but its specificity(28.42%)was lower than that of T-SPOT.TB(63.16%)and percentage of M(56.84%).(3)The sensitivity of percentage of M combined with T-SPOT.TB(parallel)and ML ratio combined with T-SPOT.TB(parallel)were 97.01% and 99.25%,and their missed diagnosis rate were 2.99%and 0.75%,respectively,for the auxiliary diagnosis of SNPT.In the differential diagnosis between SNPT and lung cancer,the specificity and misdiagnosis rate of percentage of M combined with T-SPOT.TB(series)were 94.64% and 5.36%,respectively.In the differential diagnosis between SNPT and pneumonia,the specificity of percentage of M and ML ratio combined with T-SPOT.TB(series)were 82.11% and 70.53%,respectively,and their misdiagnosis rate were 17.89% and 29.47%,respectively.Conclusions The combined detection of percentage of M and ML ratio combined with T-SPOT.TB has potential clinical value for the differential diagnosis of SNPT,lung cancer and pneumonia,which provides a simple,practicable and cheap method.It can be used as selected indicators of auxiliary diagnosis of SNPT according to the clinical needs.
作者
吕霞丽
林婷婷
高静韬
贾红彦
李自慧
舒薇
潘丽萍
张宗德
李琦
Lyu Xiali;Lin Tingting;Gao Jingtao;Jia Hongyan;Li Zihui;Shu Wei;Pan Liping;Zhang Zongde;Li Qi(Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing Chest Hospital,Capital Medical University,Beijing Key Laboratory for Drug Resistant Tuberculosis Research,Beijing 101149,China)
出处
《国际呼吸杂志》
2021年第24期1841-1847,共7页
International Journal of Respiration
基金
"十三五"国家科技重大专项(2018ZX10722301-001)
北京市科技重大专项(D181100000418005)。
关键词
涂阴肺结核
单核细胞/淋巴细胞比值
诊断价值
误诊率
Smear negative pulmonary tuberculosis
Ratio of monocytes to lymphocytes
Diagnosis accuracy
Misdiagnosis rate
作者简介
通信作者:李琦,Email:lq0703@hotmail.com。
