Klimiuk J, Krenke R, Safianowska A, Korczynski P, Chazan R
Department of Internal Medicine, Pneumonology and Alergology, Medical University of Warsaw, Banacha 1A St., 02-097, Warsaw, Poland.
Adv Exp Med Biol. 2015;852:21-30. doi: 10.1007/5584_2014_105.
Due to the paucibacillary nature of tuberculous pleural effusion the diagnosis of pleural tuberculosis is challenging. This prospective study was undertaken to evaluate the diagnostic performance of ten different pleural fluid biomarkers in the differentiation between tuberculous and non-tuberculous pleural effusions. Two hundred and three patients with pleural effusion (117 men and 86 women, median age 65 years) were enrolled. Routine diagnostic work-up, including thoracentesis and pleural fluid analysis, was performed to determine the cause of pleural effusion. The following biomarkers were measured in pleural fluid: adenosine deaminase (ADA), interferon gamma (IFN-γ), interleukin 2 soluble receptor (IL-2sRα), sub-unit p40 of interleukin 12b (IL-12p40), interleukin 18 (IL-18), interleukin 23 (IL-23), IFN-γ induced protein 10 kDa (IP-10), Fas-ligand, human macrophage-derived chemokine (MDC) and tumor necrosis factor alfa (TNF-α). There were 44 (21.7%) patients with tuberculous pleural effusion, 88 (43.3%) patients with malignant pleural effusion, 35 (17.2%) with parapneumonic effusion/pleural empyema, 30 (14.8%) with pleural transudates, and 6 (3%) with miscellaneous underlying diseases. Pleural fluid IFN-γ was found the most accurate marker differentiating tuberculous from non-tuberculous pleural effusion, with sensitivity, specificity, PPV, NPV, and AUC 97%, 98%, 95.5%, 99.4%, and 0.99, respectively. Two other biomarkers (IP-10 and Fas ligand) also showed very high diagnostic accuracy with AUC≥0.95. AUC for ADA was 0.92. We conclude that IFN-γ, IP-10, and Fas-ligand in pleural fluid are highly accurate biomarkers differentiating tuberculous from non-tuberculous pleural effusion.
由于结核性胸腔积液的菌量少，胸腔结核的诊断具有挑战性。本前瞻性研究旨在评估10种不同的胸腔积液生物标志物在鉴别结核性和非结核性胸腔积液中的诊断性能。纳入了203例胸腔积液患者（117例男性和86例女性，中位年龄65岁）。进行了包括胸腔穿刺和胸腔积液分析在内的常规诊断检查，以确定胸腔积液的病因。检测了胸腔积液中的以下生物标志物：腺苷脱氨酶（ADA）、干扰素γ（IFN-γ）、白细胞介素2可溶性受体（IL-2sRα）、白细胞介素12b亚基p40（IL-12p40）、白细胞介素18（IL-18）、白细胞介素23（IL-23）、IFN-γ诱导蛋白10 kDa（IP-10）、Fas配体、人巨噬细胞衍生趋化因子（MDC）和肿瘤坏死因子α（TNF-α）。有44例（21.7%）结核性胸腔积液患者，88例（43.3%）恶性胸腔积液患者，35例（17.2%）类肺炎性胸腔积液/胸腔积脓患者，30例（14.8%）胸腔漏出液患者，6例（3%）患有其他基础疾病。发现胸腔积液IFN-γ是鉴别结核性和非结核性胸腔积液最准确的标志物，其敏感性、特异性、阳性预测值、阴性预测值和曲线下面积分别为97%、98%、95.5%、99.4%和0.99。另外两种生物标志物（IP-10和Fas配体）也显示出非常高的诊断准确性，曲线下面积≥0.95。ADA的曲线下面积为0.92。我们得出结论，胸腔积液中的IFN-γ、IP-10和Fas配体是鉴别结核性和非结核性胸腔积液的高度准确的生物标志物。
