Department of Tuberculosis, Shenzhen Third People's Hospital, University of South China, Shenzhen, 518112, China.
Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Guangdong Medical University, Shenzhen, 518110, China.
BMC Infect Dis. 2019 Jan 16;19(1):55. doi: 10.1186/s12879-018-3654-z.
Tuberculosis (TB) remains a major public health concern on a global scale, especially in developing nations. So far, no formal guidelines are available for the diagnosis and treatment of tuberculosis pleurisy. The diagnosis of TB is worsened by the immense difficulty in differential determination of tuberculosis pleural effusion (TPE) and malignant pleural effusion (MPE). The purpose of this investigation is to assess the differential diagnostic efficiencies of the pleural IFN-γ release assay (IGRA) and widely-used biochemical parameters in the distinction analysis of TPE and MPE.
A cohort of 222 patients with pleural effusion was examined, comprising of 143 TPE and 58 MPE patients. The patients were examined with IGRA, and the widely-used biomarkers in the pleural effusion and peripheral blood.
Our results show that the TPE patients have significantly higher M. tuberculosis (Mtb) antigen-specific IFN-γ responses to ESAT-6 protein and peptide pool in the blood compared to MPE patients. TPE patients were also shown to have enriched Mtb antigen-specific IFN-γ responses in pleural effusion than in peripheral blood. Among the widely-used biomarkers, the adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in pleural effusion were better biomarkers with high sensitivity and specificity to discriminate TPE and MPE. In addition, pleural IGRA could not be affected by the pleural adhesion, and the applications of the pleural IGRA together with ADA and CEA provide a promising approach for the TPE and MPE differential identification.
Our study proposes that the integration of pleural IGRA and ADA, CEA detection could add to more effective diagnosis stratagems in the discernment between TPE and MPE.
结核病（TB）仍然是一个全球性的主要公共卫生问题，特别是在发展中国家。到目前为止，还没有针对结核性胸膜炎的诊断和治疗的正式指南。由于结核性胸腔积液（TPE）和恶性胸腔积液（MPE）的鉴别诊断非常困难，因此TB 的诊断变得更加复杂。本研究旨在评估胸腔干扰素-γ释放试验（IGRA）和广泛使用的生化参数在 TPE 和 MPE 鉴别分析中的差异诊断效率。
对 222 例胸腔积液患者进行了检查，其中包括 143 例 TPE 和 58 例 MPE 患者。对患者进行了 IGRA 检查和胸腔积液及外周血中广泛使用的生物标志物检查。
我们的结果表明，与 MPE 患者相比，TPE 患者的血液中结核分枝杆菌（Mtb）抗原特异性 IFN-γ 对 ESAT-6 蛋白和肽库的反应明显更高。TPE 患者的胸腔积液中也显示出比外周血中更丰富的 Mtb 抗原特异性 IFN-γ 反应。在广泛使用的生物标志物中，胸腔积液中的腺苷脱氨酶（ADA）和癌胚抗原（CEA）是更好的生物标志物，具有较高的灵敏度和特异性，可区分 TPE 和 MPE。此外，胸腔 IGRA 不受胸腔粘连的影响，胸腔 IGRA 与 ADA 和 CEA 的联合应用为 TPE 和 MPE 的鉴别诊断提供了一种很有前途的方法。
我们的研究表明，胸腔 IGRA 与 ADA、CEA 检测的结合可以为 TPE 和 MPE 的鉴别诊断提供更有效的诊断策略。
