Mollo Bastien, Jouveshomme Stéphane, Philippart François, Pilmis Benoît
Équipe mobile de microbiologie clinique, Laboratoire de microbiologie, Groupe-Hospitalier Paris Saint Joseph, Paris, France.
Service de pneumologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Ann Biol Clin (Paris). 2017 Feb 1;75(1):19-27. doi: 10.1684/abc.2016.1201.
Tuberculosis is one of the main etiologies to evoke in the context of lymphocyte pleurisy. However, diagnosis is difficult and is based on mycobacteriology that is not enough sensitive and time-consuming, or on histology that requires invasive biopsy gesture. This literature review, carried out from Medline, summarizes the main meta-analyzes, reviews, and originator publications in English on biomarkers, classic and more innovative, studied for the diagnosis of tuberculous pleurisy. Among the immuno-biochemical markers, interferon-γ (IFN-γ), isoenzyme of adenosine deaminase 2 (ADA2) and total adenosine deaminase (ADA) seem the most relevant with respective sensitivities of 89% (87-91), 97.2% (95 to 98.7) and 92% (90-93) and specificities of 97% (96-98), 94.2% (91.8 to 96) and 90% (89-91). About molecular biology, PCR Xpert MTB/RIF has a sensitivity of 46.4% (26.3 to 67.8), which is much higher than the direct examination, while providing rapid diagnostic confirmation, with a specificity of 99.1% (95.2 to 99.8), and a resistance to rifampicin screening. The release assay of interferon-γ (IGRA) is less effective with a sensitivity of 75% (69-81) and a specificity of 82% (75-88) in blood and a sensitivity of 80% (74-86%) and a specificity of 72% (64-80) in pleural fluid. Other biomarkers (including several cytokines) might have an interest but are still under evaluation. These innovative methods, particularly the determination of ADA and the use of PCR Xpert MTB/RIF should find their place in the diagnostic algorithm of TB pleurisy.
结核病是淋巴细胞性胸膜炎背景下的主要病因之一。然而，诊断困难，其依据是不够敏感且耗时的分枝杆菌学检查，或需要进行侵入性活检操作的组织学检查。本综述通过检索Medline，总结了英文发表的关于用于结核性胸膜炎诊断的生物标志物（包括经典和更具创新性的）的主要荟萃分析、综述及原创性研究。在免疫生化标志物中，干扰素-γ（IFN-γ）、腺苷脱氨酶2同工酶（ADA2）和总腺苷脱氨酶（ADA）似乎最为相关，其各自的敏感性分别为89%（87-91）、97.2%（95至98.7）和92%（90-93），特异性分别为97%（96-98）、94.2%（91.8至96）和90%（89-91）。在分子生物学方面，Xpert MTB/RIF PCR的敏感性为46.4%（26.3至67.8），远高于直接检查，同时能快速提供诊断确认，特异性为99.1%（95.2至99.8），并可进行利福平耐药筛查。干扰素-γ释放试验（IGRA）效果较差，血液中的敏感性为75%（69-81），特异性为82%（75-88）；胸腔积液中的敏感性为80%（74-86%），特异性为72%（64-80）。其他生物标志物（包括多种细胞因子）可能有一定价值，但仍在评估中。这些创新方法，特别是ADA的测定和Xpert MTB/RIF PCR的应用，应在结核性胸膜炎的诊断流程中占有一席之地。
