Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Thorax. 2018 Mar;73(3):240-247. doi: 10.1136/thoraxjnl-2016-209718. Epub 2017 Aug 26.
Accurate differentiating diagnosis is essential for choosing treatment for exudative pleural effusions.
To establish the diagnostic accuracy of interleukin 27 for tuberculous pleural effusion (TPE).
First, the concentrations of pleural interleukin 27, interferon-gamma and adenosine deaminase were compared between 51 patients with TPE and 103 with non-TPEs (Beijing cohort), and their diagnostic values were evaluated. These were further verified in another independent population (Wuhan cohort, n=120). In the second part of the study, we performed a meta-analysis.
With a cut-off value of 591.4 ng/L in the Beijing cohort, the area under the curve, sensitivity, specificity, positive predictive value and negative predictive value of interleukin 27 to diagnose TPE were 0.983 (95% CI 0.947 to 0.997), 96.1% (86.5% to 99.5%), 99.0% (94.7% to 100%), 98.0 (89.4 to 99.9) and 98.1 (93.3 to 99.8), respectively. Excellent diagnostic accuracy of interleukin 27 was also found in the Wuhan cohort and was further confirmed in the meta-analysis. The diagnostic performance of interleukin 27 was comparable to that of interferon-gamma and was more accurate than that of adenosine deaminase. Since the post-test probability of a negative result was always <0.1%, a negative test was considered to exclude TPE in all tuberculosis prevalence settings.
Interleukin 27 can be used to diagnose TPE in a high prevalence setting, and a negative result can also be reliably used to rule out TPE in all prevalence settings.
准确的鉴别诊断对于渗出性胸腔积液的治疗选择至关重要。
建立白细胞介素 27 对结核性胸腔积液（TPE）的诊断准确性。
首先，比较了 51 例 TPE 患者和 103 例非 TPE 患者（北京队列）的胸腔白细胞介素 27、干扰素-γ和腺苷脱氨酶浓度，并评估了它们的诊断价值。在另一个独立人群（武汉队列，n=120）中进一步验证了这些价值。在研究的第二部分，我们进行了一项荟萃分析。
在北京队列中，当截值为 591.4ng/L 时，白细胞介素 27 诊断 TPE 的曲线下面积、敏感度、特异度、阳性预测值和阴性预测值分别为 0.983（95%CI 0.947 至 0.997）、96.1%（86.5%至 99.5%）、99.0%（94.7%至 100%）、98.0（89.4%至 99.9）和 98.1（93.3%至 99.8）。白细胞介素 27 在武汉队列中也表现出了优异的诊断准确性，并在荟萃分析中得到了进一步证实。白细胞介素 27 的诊断性能与干扰素-γ相当，且比腺苷脱氨酶更准确。由于阴性结果的后验概率始终<0.1%，因此在所有结核流行率设置中，阴性检测都被认为可以排除 TPE。
白细胞介素 27 可用于高流行率环境中 TPE 的诊断，并且在所有流行率设置中，阴性结果也可可靠地排除 TPE。
