Lei Xiaoli, Wang Junli, Yang Zhigang, Zhou Shengli, Xu Zhiwei
Department of Respiratory Medicine, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China.
Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Front Med (Lausanne). 2019 Dec 17;6:301. doi: 10.3389/fmed.2019.00301. eCollection 2019.
The diagnostic value of pleural effusion mononuclear cells count for tuberculous pleurisy (TBP) is unclear. We aimed to evaluate the diagnostic value of pleural effusion mononuclear cells count and its combination with adenosine deaminase (ADA) in TBP patients. We initially analyzed 296 patients with unknown pleural effusion from the Department of Respiratory Medicine at Provincial People's Hospital during January 2014 to February 2018. Ultimately, 100 tuberculous pleurisy (TBP) patients and 105 non-tuberculous pleurisy (non-TBP) patients with pleural effusion were investigated in the current study. Meanwhile, pleural effusion mononuclear cells count and ADA test were performed to evaluate the diagnostic value for TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), accuracy and area under the receiver operating characteristic (ROC) curve (AUC) of pleural effusion mononuclear cells count only and its combination with ADA for TBP diagnosis were investigated. (i) The best cut-off value of pleural effusion mononuclear cells count for TBP diagnosis was 969.6 × 10/L, with the sensitivity, specificity and accuracy of 76, 57, and 66%, respectively. (ii) Combination of pleural effusion mononuclear cells count and ADA test suggested diagnostic value for TBP. Specifically, serial test showed the sensitivity, specificity, accuracy of 65, 90, 78%, respectively, whereas parallel test revealed the sensitivity, specificity, accuracy of 92, 45, 68%, respectively. The sensitivity of parallel test (92%) was significantly higher than pleural effusion mononuclear cells count alone (76%) (X = 23.19, < 0.001). (iii) The area under the ROC of pleural effusion mononuclear cells count and it combined with ADA were 0.66 (95% CI, 0.59-0.72) and 0.83 (95% CI, 0.78-0.89), respectively, with statistically significant difference (Z = 3.46, < 0.001). This retrospective case-control study demonstrated that pleural effusion mononuclear cells count is relatively useful for TBP diagnosis. Furthermore, the pleural effusion mononuclear cells count in combination with ADA can further improve the diagnostic accuracy of TBP.
胸腔积液单核细胞计数对结核性胸膜炎（TBP）的诊断价值尚不清楚。我们旨在评估胸腔积液单核细胞计数及其与腺苷脱氨酶（ADA）联合检测在TBP患者中的诊断价值。我们最初分析了2014年1月至2018年2月期间省立人民医院呼吸内科296例胸腔积液病因不明的患者。最终，本研究纳入了100例结核性胸膜炎（TBP）患者和105例非结核性胸膜炎（非TBP）胸腔积液患者。同时，检测胸腔积液单核细胞计数和ADA，以评估其对TBP的诊断价值。研究了仅胸腔积液单核细胞计数及其与ADA联合检测对TBP诊断的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）、阴性似然比（LR-）、准确性及受试者工作特征（ROC）曲线下面积（AUC）。（i）胸腔积液单核细胞计数诊断TBP的最佳截断值为969.6×10/L，敏感性、特异性和准确性分别为76%、57%和66%。（ii）胸腔积液单核细胞计数与ADA联合检测对TBP有诊断价值。具体而言，系列检测的敏感性、特异性、准确性分别为65%、90%、78%，而平行检测的敏感性、特异性、准确性分别为92%、45%、68%。平行检测的敏感性（92%）显著高于单纯胸腔积液单核细胞计数（76%）（X = 23.19，P < 0.001）。（iii）胸腔积液单核细胞计数及其与ADA联合检测的ROC曲线下面积分别为0.66（95%CI，0.59 - 0.72）和0.83（95%CI，0.78 - 0.89），差异有统计学意义（Z = 3.46，P < 0.001）。这项回顾性病例对照研究表明，胸腔积液单核细胞计数对TBP诊断相对有用。此外，胸腔积液单核细胞计数与ADA联合检测可进一步提高TBP的诊断准确性。
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