Diagnostic value of T cells spot test of tuberculosis infection on blood and cerebrospinal fluid for tuberculous meningitis

中华传染病杂志 Pub Date : 2018-10-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2018.10.009

Qing-luan Yang, Bingyan Zhang, Qianqian Liu, Wei Zhang, Yuanyuan Liu, X. Weng, L. Shao, Wenhong Zhang

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引用次数: 1

Abstract

Objective To evaluate the diagnostic value of T cells spot test of tuberculosis infection (T-SPOT.TB) on blood and cerebrospinal fluid for tuberculous meningitis (TBM). Methods One hundred and fifteen adult patients with suspected tuberculous meningitis were retrospectively enrolled from March 2013 to March 2017 in Huashan Hospital affiliated to Fudan University. Among them, 30 were diagnosed with TBM (7 definite, 19 highly probable and 4 possible), 37 with other infectious meningitis and 29 with non-infectious meningitis. The diagnostic sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of T-SPOT.TB on peripheral mononuclear cells (PBMC) and cerebrospinal fluid mononuclear cells (CSF-MC) were analyzed using Fisher exact test, and the diagnostic performance was evaluated by using receiver operating characteristic (ROC) curve and area under the curve (AUC). Results When including the 30 TBM cases and 66 non-TBM cases into analysis, the sensitivities and specificities, PPV and NPV of PBMC and CSF-MC for diagnosing TBM were as follows: 93.1% and 66.7%, 77% and 87.7%, 65.9% and 71.4%, 95.9% and 85.1%, respectively. When including the 30 TBM and 37 other infectious meningitis into analysis, the sensitivities and specificities, PPV and NPV of the PBMC and CSF-MC for diagnosing TBM were as follows: 93.1% and 66.7%, 68.6% and 86.5%, 71.1% and 80.0%, 92.3% and 76.2%, respectively. By ROC curve analysis, the AUC of blood and CSF were 0.882 (95%CI: 0.795-0.969) and 0.814 (95% CI: 0.704-0.925), respectively. Using a cut-off value of 32 spot forming cells (SFC) per million CSF-MC for T-SPOT.TB on CSF-MC showed a sensitivity of 66.7%, a specificity of 91.9%, PPV of 87.0% and NPV of 77.3%. The positive likelihood ratio and negative likelihood ratio were 8.22 and 0.363 respectively. Conclusions T-SPOT.TB on CSF-MC has a role in diagnosing TBM. And 32 SFC per million CSF-MC might be the optimal cut-off value to differentiate TBM and non-TBM. Key words: T cells spot test of tuberculosis infection; Cerebrospinal fluid; Tuberculosis, meningeal; Diagnosis

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血、脑脊液结核感染T细胞斑点试验对结核性脑膜炎的诊断价值

目的评价血、脑脊液结核感染T细胞斑点试验（T-spot.TB）对结核性脑膜炎（TBM）的诊断价值。方法回顾性分析2013年3月至2017年3月在复旦大学附属华山医院就诊的115例成人疑似结核性脑膜炎患者。其中30例诊断为TBM（7例确定，19例极有可能，4例可能），37例诊断为其他传染性脑膜炎，29例诊断为非传染性脑膜炎。采用Fisher精确检验分析T-SPOT.TB对外周血单个核细胞（PBMC）和脑脊液单核细胞（CSF-MC）的诊断敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并采用受试者工作特性（ROC）曲线和曲线下面积（AUC）评价其诊断性能。结果将30例TBM病例和66例非TBM病例纳入分析，PBMC和CSF-MC诊断TBM的敏感性和特异性、PPV和NPV分别为93.1%和66.7%、77%和87.7%、65.9%和71.4%、95.9%和85.1%。当将30例TBM和37例其他传染性脑膜炎纳入分析时，PBMC和CSF-MC诊断TBM的敏感性和特异性、PPV和NPV分别为：93.1%和66.7%、68.6%和86.5%、71.1%和80.0%、92.3%和76.2%。通过ROC曲线分析，血液和CSF的AUC分别为0.882（95%CI:0.795-0.969）和0.814（95%CI:0.074-0.925）。以每百万CSF-MC中32个斑点形成细胞（SFC）作为T-spot.TB的临界值，对CSF-MC的敏感性为66.7%，特异性为91.9%，PPV为87.0%，NPV为77.3%，阳性似然比和阴性似然比分别为8.22和0.363。结论T-SPOT.TB对CSF-MC有一定的诊断价值。百万CSF-MC中的32 SFC可能是区分TBM和非TBM的最佳截止值。关键词：结核感染T细胞斑点试验；脑脊液；肺结核，脑膜；诊断

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来源期刊

中华传染病杂志

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5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.