诊断T-SPOT.TB和TST的诊断准确性,用于检测风湿性免疫疾病患者的活性结核病:一个完全匹配的比较研究
Hangxing Wang1, Yuanchun Li1, Lifan Zhang2,3,4
1Department of Internal medicine, Division of Infectious Diseases, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC infectious diseases
|September 24, 2025
概括
与结核素皮肤测试 (TST) 相比,T-SPOT.TB在风湿性免疫疾病 (RD) 患者的活性结核病 (ATB) 诊断中显示出更高的准确性. 这一发现对于在高风险人群中及时诊断ATB至关重要.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 类风湿病学 类风湿病学
背景情况:
- 风湿性免疫疾病 (RD) 患者患有活跃结核病 (ATB) 的风险很高.
- 在RD患者中,准确的ATB诊断对于治疗和预后至关重要.
- 免疫功能障碍的RD患者的IGRA和TST等免疫测试的诊断准确性尚未得到充分研究.
研究的目的:
- 为了比较T-SPOT.TB和TST在RD患者的诊断准确度,怀疑有ATB症状.
- 评估这些测试在具有潜在免疫功能障碍的高风险人群中的有用性.
主要方法:
- 对具有ATB查症状的RD患者进行前性研究.
- 在T-SPOT.TB和TST测试中的性能.
- 基于临床诊断的ATB和非ATB组的分类.
- 接收器操作特征 (ROC) 曲线分析,以比较诊断准确度并确定最佳切断.
- 计算灵敏度,特异性,预测值和概率比.
主要成果:
- 与TST (AUROC 0.74) 相比,T-SPOT.TB的诊断准确度明显更高 (AUROC 0.89).
- 与TST (57.1%) 相比,T-SPOT.TB的灵敏度显著更高 (88.6%),具有相似的特异性.
- 对于T-SPOT.TB来说,最优的切线是24个SFC/106个PBMC;对于TST来说,这是5毫米的硬化.
- 在T-SPOT.TB和TST.之间观察到适度的协议 (kappa=0.466).
结论:
- 在RD患者中,T-SPOT.TB为ATB提供了卓越的诊断准确性,特别是敏感性.
- 无论是T-SPOT.TB还是TST都提供了宝贵的诊断援助.
- 增加的T-SPOT.TB点数或TST强化直径证明了对并发ATB的临床怀疑增加.
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