天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (9): 953-957.doi: 10.11958/20182194

• 临床研究 • 上一篇    下一篇

胸部CT评分对γ-干扰素释放试验阴性肺结核的诊断价值

李楠，邢志珩△，孙昕，秦中华，谢祎，陈晨，李晓军   

  1. 基金项目：天津市卫生局科技基金资助项目（2015KZ048） 作者单位：天津市海河医院，天津市呼吸疾病研究所，国家中医药管理局中医药防治传染病重点研究室（邮编300350） 作者简介：李楠（1988），女，硕士，医师，主要从事呼吸系统影像学研究 △通讯作者 E-mail: 18920696025@189.cn
  • 收稿日期:2019-01-02 修回日期:2019-07-21 出版日期:2019-09-15 发布日期:2019-09-18
  • 通讯作者: 李楠 E-mail:840455920@qq.com
  • 基金资助:
    T细胞斑点试验联合薄层CT诊断涂阴肺结核价值的研究

Diagnostic value of chest CT for interferon-gamma release assay negative pulmonary tuberculosis

LI Nan, XING Zhi-heng△, SUN Xin, QIN Zhong-hua, XIE Yi, CHEN Chen, LI Xiao-jun   

  1. Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin 300350, China △Corresponding Author E-mail:18920696025@189.cn
  • Received:2019-01-02 Revised:2019-07-21 Published:2019-09-15 Online:2019-09-18

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摘要： 目的 评价胸部CT对γ-干扰素释放试验阴性肺结核的诊断价值。方法 收集2018年1—6月于天津市 海河医院呼吸科与结核科治疗患者126例，包括确诊肺结核28例和非肺结核98例，所有患者T-Spot.TB试验检测阴 性。利用胸部CT平扫对患者进行评分并分为0~3级，分别评价各评分等级对肺结核诊断的价值。结果 确诊患者 与非确诊患者相比，胸部CT显示病变主要位于上叶尖后段、下叶背段；主要表现为树芽征及小叶核心结节、大结节、 小叶实变等。以评分3级为标准诊断肺结核，敏感度60.7%，特异度89.8%，准确度83.3%，阳性预测值63%，阴性预测 值88.9%；以评分2级为标准诊断肺结核，敏感度100%，特异度78.6%，准确度83.3%，阳性预测值57.1%，阴性预测值 100%；以评分 1 级为标准诊断肺结核，敏感度 100%，特异度 60.2%，准确度 69.0%，阳性预测值 41.8%，阴性预测值 100%。结论 胸部CT检查评分系统可以筛查出T-Spot.TB试验假阴性受试者，有效提高结核病的检出率。

关键词: 结核, 肺, 体层摄影术, X线计算机, 干扰素γ释放试验, 诊断, 鉴别, 胸部CT评分

Abstract: Objective To evaluate the diagnostic value of chest CT for interferon-gamma release assay negative pulmonary tuberculosis. Methods A total of 126 patients were collected from the Department of Respiratory and Tuberculosis of Tianjin Haihe Hospital from January to June 2018, including 28 cases of confirmed tuberculosis and 98 cases of non-tuberculosis. All patients were tested negative by T-Spot.TB test. Using chest CT plain scan, 126 patients were graded into 0-3 grades, and the diagnostic value of each grade for tuberculosis was evaluated. Results Compared with the non-diagnosed patients, chest CT showed that the lesions were mainly located in the posterior apical segment of the upper lobe and the dorsal segment of the lower lobe in patients with confirmed diagnosis. The main manifestations were tree bud sign, core nodules of lobules, large nodules and consolidation of lobules. The three class score was used as the standard diagnosis of pulmonary tuberculosis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 60.7%, 89.8%, 83.3%, 63% and 88.9%. The two class score was used as the standard diagnosis, they were 100%, 78.6%, 83.3%, 57.1% and 100%. The one class score was used as the standard diagnosis, they were 100%, 60.2%, 69.0%, 41.8% and 100%. Conclusion Chest CT scoring system can screen false negative subjects in T-Spot. TB test and can effectively improve the detection rate of tuberculosis.

Key words: tuberculosis, pulmonary, tomography, X-ray computed, interferon-gamma release tests, diagnosis, differential, chest CT score