Xu H Y, Zhang D Q, Ye J R, Su S S, Xie Y P, Chen C S, Li Y P
Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
Zhonghua Yi Xue Za Zhi. 2017 Jun 27;97(24):1862-1866. doi: 10.3760/cma.j.issn.0376-2491.2017.24.004.
To evaluate the performance of T cell enzyme-linked immuno-spot assay (T-SPOT) on peripheral blood in combination with adenosine deaminase (ADA) on pleural fluid for diagnosis of tuberculous (TB) pleurisy within different age groups. The data of patients with pleural effusion from the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from April 2012 to November 2016 were retrospectively analyzed, and the diagnoses of these patients were histopathologically confirmed through medical thoracoscopy. The cases who had confirmed diagnosis, in the same time, received peripheral blood T-SPOT.TB were enrolled. The performance of peripheral blood T-SPOT.TB in combination with pleural fluid ADA on diagnosing TB pleurisy in the younger patients (16-59 years old) and elderly patients (≥60 years old) were analyzed respectively. The sensitivity, specificity and the receiver operating characteristic (ROC) curve were adopted for statistical analysis. A total of 448 cases were finally enrolled, 341(76.1%) confirmed with TB pleurisy, 224 males, 117 females, (47±19) years old; and 107 (23.9%) classified as non-TB pleurisy, 65 males, 42 females, (61±14) years old. There were 285 cases who were classified as younger group, and the other 163 cases were classified as elderly group. The sensitivity and specificity of peripheral blood T-SPOT.TB were 85.4% (204/239) and 71.7% (33/46) in the younger patients, 76.5% (78/102) and 59.0% (36/61) respectively in the elderly patients. The sensitivity of peripheral blood T-SPOT.TB in the younger patients was significantly higher than that in the elderly patients (=0.047). The sensitivity and specificity were 99.2% and 95.7% in combination with peripheral blood T-SPOT.TB and pleural fluid ADA respectively in the younger patients. The area under ROC curve (AUC) of T-SPOT.TB in the younger patients was 0.833, AUC of T-SPOT.TB combined with ADA was 0.911. The combination test of 2 tests had the sensitivity of 96.1% and the specificity of 90.2% respectively in the elderly patients. The AUC of T-SPOT.TB in the elderly patients was 0.747, AUC of T-SPOT.TB combined with ADA was 0.911. Peripheral blood T-SPOT.TB combined with pleural fluid ADA can improve the diagnostic performance for TB pleurisy with different ages, especially for elderly patients who can't tolerate pleural biopsy.
评估外周血T细胞酶联免疫斑点试验（T-SPOT）联合胸水腺苷脱氨酶（ADA）对不同年龄组结核性胸膜炎的诊断价值。回顾性分析温州医科大学附属第一医院呼吸与危重症医学科2012年4月至2016年11月胸腔积液患者资料，所有患者均经内科胸腔镜组织病理学确诊。选取确诊患者同时行外周血T-SPOT.TB检测。分别分析外周血T-SPOT.TB联合胸水ADA对年轻患者（16～59岁）和老年患者（≥60岁）结核性胸膜炎的诊断效能。采用敏感度、特异度及受试者工作特征（ROC）曲线进行统计学分析。最终纳入448例患者，其中结核性胸膜炎341例（76.1%），男224例，女117例，年龄（47±19）岁；非结核性胸膜炎107例（23.9%），男65例，女42例，年龄（61±14）岁。其中年轻组285例，老年组163例。年轻患者外周血T-SPOT.TB敏感度和特异度分别为85.4%（204/239）和71.7%（33/46），老年患者分别为76.5%（78/102）和59.0%（36/61）。年轻患者外周血T-SPOT.TB敏感度显著高于老年患者（P=0.047）。年轻患者外周血T-SPOT.TB联合胸水ADA敏感度和特异度分别为99.2%和95.7%。年轻患者T-SPOT.TB的ROC曲线下面积（AUC）为0.833，T-SPOT.TB联合ADA的AUC为0.911。老年患者两项联合检测敏感度和特异度分别为96.1%和90.2%。老年患者T-SPOT.TB的AUC为0.747，T-SPOT.TB联合ADA的AUC为0.911。外周血T-SPOT.TB联合胸水ADA可提高不同年龄组结核性胸膜炎的诊断效能，尤其对于不能耐受胸膜活检的老年患者。
