鉴别结核性胸膜炎与其他渗出性淋巴细胞性胸腔积液。

Petborom Pichaya, Dechates Bothamai, Muangnoi Panunat

HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.

Ann Palliat Med. 2020 Sep;9(5):2508-2515. doi: 10.21037/apm-19-394. Epub 2020 Aug 27.

BACKGROUND

Recently, the combination of clinical and pleural fluid data can be used to calculate a score which helps facilitate differential diagnosis between tuberculous pleuritis (TBP) and No-TBP effusions. However, a reliable determination of adenosine deaminase (ADA) remains difficult to obtain in Thailand. Therefore, the aim of our study was set out to develop a scoring which makes use of clinical and pleural fluid data.

METHODS

A retrospective study involved 15 patients with TBP and 41 patients with no-TBP. The clinical and pleural fluid data of all patients from January 1, 2011, 32 to December 31, 2014, were collected. The diagnostic sensitivity, specificity, positive and negative predictive value were calculated.

RESULTS

The parameters were superior in detecting TBP, including the ADA ≥17.5 U/L, In scoring I [ADA ≥40 U/L, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃, and RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L] as ≥1.5 points, and scoring II [no previous history of cancer, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃ RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L, pleural protein ≥50 g/L, and LDH ratio ≥2.2] as ≥4.5 points, since the area under curve (AUC) 74.0%, 74.0%, and 81.0%, sensitivity 73.3%, 73.3%, and 71.4%, and specificity 68.7%, 62.5%, and 71.1%, respectively). Moreover, no previous history of cancer and lower RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L indicated sensitivity (90.6% and 65.5%), and specificity (70.0% and 44.4%), respectively. Summated scores of ≥5 points in model 1 and ≥6 points in model 2 yielded measures of sensitivity (46.7% and 57.1%), and specificity (84.4% and 80.5%), respectively.

CONCLUSIONS

The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.

背景

最近，临床和胸腔积液数据的结合可用于计算一个分数，有助于促进结核性胸膜炎（TBP）与非TBP性胸腔积液之间的鉴别诊断。然而，在泰国仍难以获得可靠的腺苷脱氨酶（ADA）测定结果。因此，我们的研究目的是开发一种利用临床和胸腔积液数据的评分系统。

方法

一项回顾性研究纳入了15例TBP患者和41例非TBP患者。收集了2011年1月1日至2014年12月31日期间所有患者的临床和胸腔积液数据。计算了诊断敏感性、特异性、阳性和阴性预测值。

结果

在检测TBP方面，这些参数表现出色，包括ADA≥17.5 U/L，在评分I中[ADA≥40 U/L，年龄≥35岁，体温≥37.8℃，红细胞计数（RBC）≥1.5×10⁹/L]计为≥1.5分，以及在评分II中（无癌症病史，年龄≥35岁，体温≥37.8℃，RBC≥1.5×10⁹/L，胸腔积液蛋白≥50 g/L，乳酸脱氢酶（LDH）比值≥2.2）计为≥4.5分，因为曲线下面积（AUC）分别为74.0%、74.0%和81.0%，敏感性分别为73.3%、73.3%和71.4%，特异性分别为68.7%、62.5%和71.1%）。此外，无癌症病史且RBC≥1.5×10⁹/L时，敏感性分别为90.6%和65.5%，特异性分别为70.0%和44.4%。模型1中总分≥5分和模型2中总分≥6分的敏感性分别为46.7%和57.1%，特异性分别为84.4%和80.5%。