Aggarwal Ashutosh Nath, Agarwal Ritesh, Dhooria Sahajal, Prasad Kuruswamy Thurai, Sehgal Inderpaul Singh, Muthu Valliappan
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cytokine. 2021 May;141:155467. doi: 10.1016/j.cyto.2021.155467. Epub 2021 Feb 17.
Tumor necrosis factor (TNF) is an important local host response mediator in tuberculous pleural effusion (TPE) and is proposed as a potential biomarker for diagnosing TPE. We assessed the performance of pleural fluid TNF in the diagnosis of TPE, and evaluated its ability to distinguish TPE from parapneumonic or malignant effusions.
We queried the PubMed and Embase databases for studies indexed till August 2020. We included studies that (a) provided data on sensitivity and specificity of pleural fluid TNF for the diagnosis of TPE, or (b) compared pleural fluid TNF levels between TPE and malignant or parapneumonic effusions. We used a hierarchical summary receiver operating characteristic plot to model summary sensitivity and specificity. A random effects model was used to pool standardized mean differences (SMD) across studies comparing TPE and other effusions. We explored heterogeneity using subgroup analysis. We also performed meta-regression to identify factors significantly influencing results.
We retrieved 1090 citations, and included 38 publications, in our review. The summary estimates for sensitivity, specificity, and diagnostic odds ratio were 0.79 (95% CI 0.72-0.84), 0.82 (95% CI 0.76-0.87), and 16.84 (95% CI 9.47-29.95) respectively. Pleural fluid TNF levels were significantly higher in TPE than in malignant effusions (summary SMD 1.50, 95% CI 1.13-1.87), but not parapneumonic effusions (summary SMD 0.61, 95% CI -0.14 to 1.35). None of the prespecified subgroup variables significantly influenced summary estimates.
Pleural fluid TNF has poor diagnostic accuracy for diagnosing TPE and imperfectly discriminates TPE from parapneumonic pleural effusions.
肿瘤坏死因子（TNF）是结核性胸腔积液（TPE）中一种重要的局部宿主反应介质，被认为是诊断TPE的潜在生物标志物。我们评估了胸腔积液TNF在TPE诊断中的性能，并评估其区分TPE与肺炎旁或恶性胸腔积液的能力。
我们检索了截至2020年8月的PubMed和Embase数据库中的研究。我们纳入了以下研究：（a）提供了胸腔积液TNF诊断TPE的敏感性和特异性数据，或（b）比较了TPE与恶性或肺炎旁胸腔积液之间的胸腔积液TNF水平。我们使用分层汇总接收器操作特征图来模拟汇总敏感性和特异性。使用随机效应模型汇总比较TPE与其他胸腔积液的研究中的标准化平均差异（SMD）。我们通过亚组分析探索异质性。我们还进行了meta回归以确定显著影响结果的因素。
我们检索到1090条引文，并在综述中纳入了38篇出版物。敏感性、特异性和诊断比值比的汇总估计分别为0.79（95%CI 0.72 - 0.84）、0.82（95%CI 0.76 - 0.87）和16.84（95%CI 9.47 - 29.95）。TPE中的胸腔积液TNF水平显著高于恶性胸腔积液（汇总SMD 1.50，95%CI 1.13 - 1.87），但与肺炎旁胸腔积液相比无显著差异（汇总SMD 0.61，95%CI -0.14至1.35）。预先设定的亚组变量均未显著影响汇总估计。
胸腔积液TNF对TPE的诊断准确性较差，且不能很好地区分TPE与肺炎旁胸腔积液。
