目的: 探讨T淋巴细胞酶联斑点实验(T-SPOT)、结核菌素皮肤试验(tuberculin test, TST)以及结核抗体(tuberculosis antibody)在矽肺合并肺结核(pulmonary silicosis complicated with tuberculosis)诊断中的应用价值。方法: 收集2015年8月7日至2016年5月20日确诊为矽肺结核感染患者41例、非矽肺结核患者90例、健康体检学生对照组40例, 对三组人群经以上免疫学方法检测的结果进行统计分析。结果: 1)矽肺结核、非矽肺结核及健康人群中T-SPOT阳性率分别为73.17%、93.33%、15%, 三者两两比较差异有统计学意义; 矽肺结核、非矽肺结核及健康人群中TST阳性率分别为58.54%、88.89%、32.5%, 非矽肺结核患者与健康人群及矽肺结核患者之间, 差异均有统计学意义, 但矽肺结核患者与健康人群之间, 差异无统计学意义; 矽肺结核、非矽肺结核及健康人群中结核抗体阳性率分别为36.58%、42.22%、52.5%, 三者两两比较差异均无统计学意义。2)三种检测方法在矽肺结核患者中的敏感性分别为73.17%、58.54%、36.58%, 差异有统计学意义, 其中T-SPOT及TST的敏感性均高于结核抗体方法(P<0.05); 特异性分别为85%、67.5%、47.5%, 其中T-SPOT的特异性高于结核抗体方法(P<0.05); 阳性预测值分别为83.33%、64.86%、41.67%, 阴性预测值分别为75.56%、61.36%、42.22%, 三种方法的阳性及阴性预测值存在差异, 均有统计学意义。3)T-SPOT在I、II、III期矽肺结核检测的阳性率分别为52.38%、94.12%、100%, I期与II期或III期的阳性率之间差异有统计学意义, II期与III期之间阳性率差异无统计学意义。结论: T-SPOT方法具有较高的敏感性及特异性, 对矽肺结核辅助诊断及临床分期具有较好的应用价值。

Objective:To investigate the value of T lymphocyte ELISA dot experiment (T-SPOT), tuberculin skin test (TST) and tuberculosis antibody in the diagnosis of.patients with pulmonary tuberculosis in silicosis. Methods:Forty-one cases of silicosis TB infection, ninety cases of non silicosis tuberculosis, forty cases of healthy medical students as control group were collected from August 7, 2015 to May 20, 2016, all the above samples were detected by the above three immunological methods, and the resuts of different methods were analyzed. Result:1) the positive rates of T-SPOT in silicosis, non silicosis tuberculosis and healthy people were 73.17%, 93.33% and 15% respectively, there were significant differences between the two groups in the three methods:The positive rates of TST in silicosis, non silicosistuberculosis and healthy people were 58.54%, 88.89% and 32.5% respectively, compared with non silicosis TB patients, the differences were statistically significant. There were no significant differences between healthy people and silicosis patients, Compared with non silicosis patients, the differences between healthy people and non silicosis patients were statistically significant. The positive rates of TB antibody in silicosis, non silicosis, tuberculosis and healthy people were 36.58%, 42.22% and 52.5%, respectively. There were no statistically significant differences between the two groups in the three methods. 2) the sensitivity of the three detection methods in silicosis patients was 73.17%, 58.54% and 36.58%, respectively, and the differences were statistically significant:The sensitivity of T-SPOT and TST was higher than that of TB antibody, the differences were statistically significant, the specificity was 85%, 67.5% and 47.5%, respectively, the differences were statistically significant, The specificity of T-SPOT was higher than that of tuberculosis antibody method, the difference was statistically significant; the positive predictive value were 83.33%, 64.86%, 41.67%, and negative predictive value were 75.56%, 61.36%, 64.44%, the differences between positive and negative predictive value of three methods, were statistically significant. 3) the positive rate of T-SPOT in I, II, III phase tuberculosilicosis detection was 52.38%, 94.12%, 100%, there were significant difference between the positive rate of I and II phase or III phase, there were no significant difference between II and III positive rate. Conclusion:T-SPOT has high sensitivity and specificity, and is an effective methodin the diagnosis and clinical staging of silicosis.