应用内科胸腔镜、腺苷脱氨酶及结核感染T细胞检测的诊断流程图在结核性胸腔积液诊断中的评估

Evaluation of a diagnostic flow chart applying medical thoracoscopy, adenosine deaminase and T-SPOT.TB in diagnosis of tuberculous pleural effusion.

作者信息

He Y, Zhang W, Huang T, Wang X, Wang M

机构信息

Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

出版信息

Eur Rev Med Pharmacol Sci. 2015 Oct;19(19):3563-8.

PMID:26502844

Abstract

OBJECTIVE

To evaluate a diagnostic flow chart applying medical thoracoscoy (MT), adenosine deaminase (ADA) and T-SPOT.TB in diagnosis of tuberculous pleural effusion (TPE) at a high TB burden country.

PATIENTS AND METHODS

136 patients with pleural effusion (PE) were enrolled and divided into TPE and Non-TPE group. MT (histology), PE ADA and T-SPOT.TB were conducted on all patients. ROC analysis was performed for the best cut-off value of PE ADA in detection of TPE. The diagnostic flow chart applying MT, ADA and T-SPOT.TB was evaluated for improving the limitations of each diagnostic method.

RESULTS

ROC analysis showed that the best cut-off value of PE ADA was 30U/L. The sensitivity and specificity of these tests were calculated respectively to be: 71.4% (58.5%-81.6%) and 100% (95.4-100.0%) for MT, 92.9% (83.0-97.2%) and 68.8% (57.9-77.9%) for T-SPOT.TB, and 80.0% (69.6-88.1%) and 92.9% (82.7-98.0%) for PE ADA. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value of the diagnostic flow chart were 96.4% (87.9-99.0%), 96.3% (89.6-98.7%), 25.714, 0.037, 97.4 and 94.9, respectively.

CONCLUSIONS

The diagnostic flow chart applying MT, ADA and T-SPOT.TB is an accurate and rapid diagnostic method in detection of TPE.

摘要

目的

在结核病高负担国家评估应用内科胸腔镜（MT）、腺苷脱氨酶（ADA）和T-SPOT.TB的诊断流程图在结核性胸腔积液（TPE）诊断中的作用。

患者与方法

纳入136例胸腔积液（PE）患者，分为TPE组和非TPE组。对所有患者进行MT（组织学检查）、胸腔积液ADA检测及T-SPOT.TB检测。对胸腔积液ADA检测TPE的最佳截断值进行ROC分析。评估应用MT、ADA和T-SPOT.TB的诊断流程图，以改善每种诊断方法的局限性。

结果

ROC分析显示胸腔积液ADA的最佳截断值为30U/L。这些检测的敏感性和特异性分别计算为：MT的敏感性和特异性分别为71.4%（58.5%-81.6%）和100%（95.4%-100.0%）；T-SPOT.TB的敏感性和特异性分别为92.9%（83.0%-97.2%）和68.8%（57.9%-77.9%）；胸腔积液ADA的敏感性和特异性分别为80.0%（69.6%-88.1%）和92.9%（82.7%-98.0%）。诊断流程图的敏感性、特异性、阳性似然比、阴性似然比、阳性预测值和阴性预测值分别为96.4%（87.9%-99.0%）、96.3%（89.6%-98.7%）、25.714、0.037、97.4和94.9。