Pulmonary and Clinical Laboratory (ICHC) Divisions, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Respirology. 2009 Nov;14(8):1128-33. doi: 10.1111/j.1440-1843.2009.01621.x.
Tuberculosis (TB) and cancer are two of the main causes of pleural effusions which frequently share similar clinical features and pleural fluid profiles. This study aimed to identify diagnostic models based on clinical and laboratory variables to differentiate tuberculous from malignant pleural effusions.
A retrospective study of 403 patients (200 with TB; 203 with cancer) was undertaken. Univariate analysis was used to select the clinical variables relevant to the models composition. Variables beta coefficients were used to define a numerical score which presented a practical use. The performances of the most efficient models were tested in a sample of pleural exudates (64 new cases).
Two models are proposed for the diagnosis of effusions associated with each disease. For TB: (i) adenosine deaminase (ADA), globulins and the absence of malignant cells in the pleural fluid; and (ii) ADA, globulins and fluid appearance. For cancer: (i) patient age, fluid appearance, macrophage percentage and presence of atypical cells in the pleural fluid; and (ii) as for (i) excluding atypical cells. Application of the models to the 64 pleural effusions showed accuracy higher than 85% for all models.
The proposed models were effective in suggesting pleural tuberculosis or cancer.
结核病（TB）和癌症是胸腔积液的两个主要原因，它们经常具有相似的临床特征和胸腔积液特征。本研究旨在确定基于临床和实验室变量的诊断模型，以区分结核性和恶性胸腔积液。
对 403 名患者（200 例结核；203 例癌症）进行回顾性研究。单变量分析用于选择与模型组成相关的临床变量。变量的 beta 系数用于定义一个实用的数值评分。在胸腔渗出液样本中（64 例新病例）测试了最有效的模型的性能。
为诊断与每种疾病相关的胸腔积液提出了两种模型。对于 TB：（i）腺苷脱氨酶（ADA）、球蛋白和胸腔积液中无恶性细胞；以及（ii）ADA、球蛋白和液体外观。对于癌症：（i）患者年龄、液体外观、巨噬细胞百分比和胸腔积液中存在非典型细胞；以及（ii）与（i）相同，不包括非典型细胞。将这些模型应用于 64 例胸腔积液中，所有模型的准确率均高于 85%。
所提出的模型可有效提示结核性或癌性胸腔积液。
