Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of General Medicine, Bishan District People's Hospital, Chongqing, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Respiratory Medicine, Wanzhou District People's Hospital, Chongqing, China.
Int J Infect Dis. 2019 Apr;81:38-42. doi: 10.1016/j.ijid.2019.01.045. Epub 2019 Jan 30.
Although pleural effusion is a common clinical manifestation, the differential diagnosis of the cause of pleural effusion is often challenging, especially in the early differentiation of tuberculous pleurisy (TP) from other pleural effusion. The aim of this study was to evaluate the performance of commonly used laboratory tests for the early diagnosis of difficult cases of pleural effusion.
Patients with undiagnosed pleural effusion were enrolled and subjected to five laboratory tests including thoracoscopy, pleural fluid adenosine deaminase assay (ADA), serum tuberculosis antibody test (TB-antibody), tuberculin skin test (TST), and T-SPOT.TB assay. The diagnosis of TP was established based on pleural histology and mycobacterial culture. The different tests were compared for diagnostic performance.
A total of 106 patients were enrolled; their mean age was 53 years and 70.8% were male. Seventy-two (68%) of them were confirmed to have TP. When used individually, the five laboratory tests showed highly variable performance parameters, including sensitivity ranging from 46% to 92% and specificity ranging from 33% to 82%. When used in different combinations, thoracoscopy combined with TST or TB-antibody showed the optimal performance parameters, with a sensitivity of 80.8% and a specificity of 85.7%.
The results of this study suggest that the combination of thoracoscopy with TST or TB-antibody test is the best choice for the early diagnosis of difficult cases of TP in high TB burden countries.
虽然胸腔积液是一种常见的临床表现，但胸腔积液病因的鉴别诊断通常具有挑战性，尤其是在早期区分结核性胸膜炎（TP）与其他胸腔积液时。本研究旨在评估常用于胸腔积液疑难病例早期诊断的实验室检测的性能。
纳入了患有不明原因胸腔积液的患者，并对包括胸腔镜检查、胸腔积液腺苷脱氨酶检测（ADA）、血清结核抗体检测（TB-antibody）、结核菌素皮肤试验（TST）和 T-SPOT.TB 检测在内的 5 种实验室检测进行了检测。TP 的诊断是基于胸腔组织学和分枝杆菌培养。比较了不同检测的诊断性能。
共纳入 106 例患者，平均年龄为 53 岁，70.8%为男性。其中 72 例（68%）被确诊为 TP。当单独使用时，这 5 种实验室检测的性能参数差异较大，包括敏感性为 46%至 92%，特异性为 33%至 82%。当用于不同组合时，胸腔镜联合 TST 或 TB-antibody 检测表现出最佳的性能参数，敏感性为 80.8%，特异性为 85.7%。
本研究结果表明，在高结核负担国家，胸腔镜联合 TST 或 TB-antibody 检测是早期诊断 TP 疑难病例的最佳选择。
