Chennaiyan Baranidharan, Bhatt Arun N, Kancherla Roopa, Kuriakose Cijoy K, Dev Anand Vimal, Philip George A
Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India.
Department of Community Medicine, MOSC Medical College, Ernakulam, Kerala, India.
J Family Med Prim Care. 2016 Jul-Sep;5(3):615-618. doi: 10.4103/2249-4863.197322.
Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity of the pleural fluid study of proteins, lactate dehydrogenase (LDH), and cell counts in diagnosis of tuberculous pleuritis.
This was a cross-sectional study conducted in a 300 bedded secondary care hospital in rural Tamil Nadu. Exhaustive sampling was performed during April 2013 to March 2014. Pleural fluid study of 54 patients with exudative pleural effusion was conducted. Diagnosis was established by closed needle pleural biopsy. Receiver operator curves were plotted and area under curve (AUC) was calculated for various parameters. Sensitivity, specificity, and predictive values were calculated for different cut-off values of the parameter with significant AUC.
Prevalence of tuberculous pleural effusion was 56% (95% confidence interval [95% CI] - 42.5-69.5%). Lymphocyte predominance in pleural fluid was the only valid test, and cut-off >80% had sensitivity of 70.0% (95% CI - 53.3-86.7%) and specificity of 70.8% (95% CI - 52.2-89.4%). Pleural fluid pH, protein or its ratio with serum protein, sugar, total leukocyte count, LDH or its ratio with serum LDH; erythrocyte sedimentation rate were not valid screening tests.
Lymphocyte predominance > 80% can be used as a marker of tuberculous pleuritis. Since the prevalence of tuberculous pleuritis in India has come down considerably, newer tests need to be included to make a valid diagnosis.
大多数印度人生活在农村地区，这些资源有限的地区依赖更便宜且侵入性较小的检测来诊断肺外结核病（TB）。该国结核病患病率的下降可能会影响诊断的有效性。目的是评估胸水蛋白质、乳酸脱氢酶（LDH）和细胞计数研究在结核性胸膜炎诊断中的有效性。
这是一项在泰米尔纳德邦农村一家拥有300张床位的二级护理医院进行的横断面研究。在2013年4月至2014年3月期间进行了详尽的采样。对54例渗出性胸腔积液患者进行了胸水研究。通过闭合针吸胸膜活检确诊。绘制了受试者操作曲线，并计算了各种参数的曲线下面积（AUC）。针对具有显著AUC的参数的不同临界值计算了敏感性、特异性和预测值。
结核性胸腔积液的患病率为56%（95%置信区间[95%CI] - 42.5 - 69.5%）。胸水中淋巴细胞占优势是唯一有效的检测方法，临界值>80%时敏感性为70.0%（95%CI - 53.3 - 86.7%），特异性为70.8%（95%CI - 52.2 - 89.4%）。胸水pH值、蛋白质或其与血清蛋白的比值、糖、白细胞总数、LDH或其与血清LDH的比值；红细胞沉降率均不是有效的筛查试验。
淋巴细胞占优势>80%可作为结核性胸膜炎的标志物。由于印度结核性胸膜炎的患病率已大幅下降，需要纳入更新的检测方法以进行有效的诊断。
