“三位一体法”诊断不典型肾结核的应用价值

doi:10.3969/j.issn.1007-3205.2025.02.007

摘要/Abstract

摘要： 目的探讨“三位一体法”，即螺旋CT平扫（computed tomography,CT）联合结核感染T细胞斑点检测（T cell spot detection of tuberculosis infection，T-SPOT.TB）、利福平耐药实时荧光定量核酸扩增技术(rifampicin resistance real-time fluorescence quantitative nucleic acid amplification,GeneXpert MTB/RIF）在不典型肾结核诊断中的应用价值。
方法搜集河北省胸科医院泌尿外科诊治的75例经过结核菌培养或术后病理确诊的不典型肾结核患者为结核组，另搜集非结核性肾病患者75例作为对照组，以最终的临床诊断为金标准，比较不同检测方法诊断不典型肾结核的敏感度、特异度、准确度和受试者工作特征（receiver operating characteristic,ROC）曲线下面积（area under curve，AUC）的差异。
结果 ①CT、T-SPOT.TB、CT联合T-SPOT.TB、GeneXpert MTB/RIF的敏感度均高于结核菌培养（84.00%、100.00%、84.00%、62.67%、9.33%），CT联合T-SPOT.TB的敏感度低于T-SPOT.TB（84.00%、100.00%），但与CT差异无统计学意义（84.00%、84.00%）。②CT、T-SPOT.TB的特异度低于结核菌培养（85.33%、74.67%、100.00%）,CT联合T-SPOT.TB、GeneXpert MTB/RIF与结核菌培养的特异度差异无统计学意义（97.33%、100.00%、100.00%）,CT联合T-SPOT.TB高于两者单独应用（97.33%、85.33%、74.67%）。③CT、T-SPOT.TB、CT联合T-SPOT.TB、GeneXpert MTB/RIF的准确度均高于结核菌培养(84.67%、87.33%、90.67%、81.33%、54.67%)，CT联合T-SPOT.TB的准确度高于两者单独应用（90.67%、84.67%、87.33%）。④CT、T-SPOT.TB、CT联合T-SPOT.TB、GeneXpert MTB/RIF的AUC均高于结核菌培养（AUC=0.847、0.873、0.907、0.813、0.547），CT联合T-SPOT.TB的AUC高于两者单独应用（AUC=0.907、0.847、0.873）。
结论螺旋CT平扫联合T-SPOT.TB与GeneXpert MTB/RIF可提高不典型肾结核的临床检出率和病原学诊断效能，推荐临床应用“三位一体法”诊断不典型肾结核。

关键词: 结核, 肾, 体层摄影术,螺旋计算机, 结核分枝杆菌

Abstract: Objective To discuss the application value of the "Trinity Method", which combines spiral computed tomography (CT) plain scan, T cell spot detection of tuberculosis infection (T-SPOT.TB) and rifampicin resistance real-time fluorescence quantitative nucleic acid amplification (GeneXpert MTB/RIF), in the diagnosis of atypical renal tuberculosis.
Methods In total, 75 patients with atypical renal tuberculosis diagnosed by Mycobacterium tuberculosis culture or postoperative pathological diagnosis and treated in the Department of Urology, Hebei Chest Hospital were enrolled as the tuberculosis group, and another 75 patients with non-tuberculous nephropathy were enrolled as the control group. The sensitivity, specificity, accuracy and area under curve (AUC) of different detection methods in the diagnosis of atypical renal tuberculosis were compared, with the final clinical diagnosis as the gold standard.
Results ① The sensitivity of CT, T-SPOT.TB, CT combined with T-SPOT.TB, and GeneXpert MTB/RIF was higher than that of Mycobacterium tuberculosis culture (84.00%, 100.00%, 84.00%, 62.67%, 9.33%, respectively). The sensitivity of CT combined with T-SPOT.TB was lower than that of T-SPOT.TB (84.00%, 100.00%), but there was no significant difference compared with CT (84.00%, 84.00%). ②The specificity of CT and T-SPOT.TB was lower than that of Mycobacterium tuberculosis culture (85.33%, 74.67%, 100.00%). There was no significant difference in the specificity of CT combined with T-SPOT.TB, GeneXpert MTB/RIF and Mycobacterium tuberculosis culture (97.33%, 100.00%, 100.00%). The specificity of CT combined with T-SPOT.TB was higher than that of each indicator alone (97.33%, 85.33%, 74.67%).③The accuracy of CT, T-SPOT.TB, CT combined with T-SPOT.TB and GeneXpert MTB/RIF was higher than that of Mycobacterium tuberculosis culture (84.67%, 87.33%, 90.67%, 81.33%, 54.67%, respectively). The accuracy of CT combined with T-SPOT.TB was higher than that of each indicator alone (90.67%, 84.67%, 87.33%). ④The AUC of CT, T-SPOT.TB, CT combined with T-SPOT.TB, GeneXpert MTB/RIF was higher than that of Mycobacterium tuberculosis culture (AUC=0.847, 0.873, 0.907, 0.813, 0.547). The AUC of CT combined with T-SPOT.TB was higher than that of each indicator alone (AUC=0.907, 0.847, 0.873).
Conclusion Spiral CT plain scan combined with T-SPOT TB and GeneXpert MTB/RIF can improve the clinical detection rate and pathogenic diagnostic efficacy of atypical renal tuberculosis. It is recommended to use the "Trinity Method" in clinical diagnosis of atypical renal tuberculosis.

Key words: tuberculosis, renal, tomography, spiral computed, Mycobacterium tuberculosis

李崇斌, 尹航, 范正超, 刘建震, 黄天浩. “三位一体法”诊断不典型肾结核的应用价值 [J]. 河北医科大学学报, 2025, 46(2): 166-171.

LI Chong-bin, YIN Hang, FAN Zheng-chao, LIU Jian-zhen, HUANG Tian-hao. The application value of the "Trinity Method" in the diagnosis of atypical renal tuberculosis [J]. Journal of Hebei Medical University, 2025, 46(2): 166-171.

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“三位一体法”诊断不典型肾结核的应用价值

The application value of the "Trinity Method" in the diagnosis of atypical renal tuberculosis

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