Clinical Value of Xpert MTB/RIF Combined with T-SPOT.TB in Early Diagnosis of Tuberculous Meningitis
Objective To explore the clinical value of Xpert Mycobacterium tuberculosis/rifampin(Xpert MTB/RIF)combined with T-cells enzyme linked immunospot(TSPOT.TB)in early diagnosis of tuberculous meningitis.Methods A total of 90 suspected tuberculous meningitis patients admitted to Henan Chest Hospital from October 2019 to September 2022 were collected.They were classified into meningitis group(46 cases)and non-meningitis group(44 cases).Cerebrospinal fluid acid-fast staining,cerebrospinal fluid Xpert MTB/RIF and peripheral blood T-SPOT.TB were tested for all subjects.The diagnostic positive rate,negative rate and accuracy rate of each single detection method and combined detection were compared.Sensitivity,specificity,positive predictive value,negative predictive value and receiver operating characteristic curve were evaluated the diagnostic value of each detection method.Results The positive rates of TSPOT.TB and Xpert MTB/RIF(69.57％and 60.87％)were higher than those of acid-fast staining(19.57％).The diagnostic positive rate of parallel detection of TSPOT.TB and Xpert MTB/RIF(89.13％)was higher than those of series detection(60.87％)and all single detection methods(P＜0.05).The diagnostic accuracy of parallel detection(90.00％)was higher than those of series detection(78.89％)and Xpert MTB/RIF detection(77.78％)(P＜0.05).The sensitivity and negative predictive value of parallel detection for tuberculous meningitis were 89.13％and 88.89％,respectively,which were higher than those of serial detection and single detection.The specificity and positive predictive value of parallel detection were 90.91％and 91.11％,respectively,which were not different from the series detection and single detection methods.Area under curve area of parallel detection was the highest,reaching 0.900(95％CI:0.828-0.972).Conclusion TSPOT.TB and Xpert MTB/RIF are used in the diagnosis of tuberculous meningitis.Compared with traditional methods,they have better sensitivity and specificity.Parallel detection can significantly improve the diagnostic efficiency of tuberculous meningitis,which is conducive to early diagnosis and treatment.
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