Ren Zeng-Hua, Xu Ling
Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Am J Med Sci. 2021 Apr;361(4):469-478. doi: 10.1016/j.amjms.2020.10.015. Epub 2020 Oct 24.
Tuberculous pleural effusion (TPE) is usually characterized by lymphocytic predominance and high pleural fluid adenosine deaminase (pfADA), while parapneumonic pleural effusion (PPE) is usually characterized by neutrophilic predominance. However, in some cases, neutrophils can be predominant in TPE. In such cases, the differential diagnosis between TPE and PPE is challenging and has been rarely investigated. The aim of this study was to evaluate the accuracy of pfADA, pleural fluid lactate dehydrogenase (pfLDH) and other parameters, such as age/pfADA in the differential diagnosis of neutrophil-predominant TPE (NP-TPE) and PPE.
Between January 2003 and August 2018, 19 patients with NP-TPE and 54 patients with PPE at Shanghai Jiao Tong University Affiliated Sixth People's Hospital were retrospectively reviewed. Age, blood and pleural fluid findings, and eight ratios that consisted of routine biomarkers were compared between the two groups in ≤50 and >50 years old groups. ROC curve analysis was used to evaluate diagnostic performance.
The three parameters with the largest AUC were age/pfADA, pfADA and pfLDH in ≤ 50 years old group, and pfADA, age/pfADA and the percentage of neutrophils in pleural fluid (pfN%) in >50 years old group. For patients ≤ 50 years old, pfADA combined with pfLDH or age/pfADA combined with pfLDH could increase the specificity to 100%, while the sensitivity of the former was high (84.6% vs 76.9%). For patients >50 years old, both pfADA combined with pfN% and age/pfADA combined with pfN% could increase the specificity to 90.3% with the same sensitivity.
Although pfADA played an important role in the discrimination of NP-TPE from PPE, combining pfADA with pfLDH for patients ≤50 years old or combining pfADA with pfN% for patients >50 years old might improve diagnostic performance.
结核性胸腔积液（TPE）通常以淋巴细胞为主且胸腔积液腺苷脱氨酶（pfADA）升高为特征，而类肺炎性胸腔积液（PPE）通常以中性粒细胞为主。然而，在某些情况下，TPE中中性粒细胞可能占优势。在这种情况下，TPE和PPE的鉴别诊断具有挑战性，且很少被研究。本研究的目的是评估pfADA、胸腔积液乳酸脱氢酶（pfLDH）以及其他参数，如年龄/pfADA在以中性粒细胞为主的TPE（NP-TPE）和PPE鉴别诊断中的准确性。
回顾性分析2003年1月至2018年8月在上海交通大学附属第六人民医院就诊的19例NP-TPE患者和54例PPE患者。比较两组年龄≤50岁和>50岁患者的年龄、血液和胸腔积液检查结果，以及由常规生物标志物组成的八个比值。采用ROC曲线分析评估诊断性能。
在≤50岁组中，曲线下面积（AUC）最大的三个参数是年龄/pfADA、pfADA和pfLDH；在>50岁组中，是pfADA、年龄/pfADA和胸腔积液中性粒细胞百分比（pfN%）。对于≤50岁的患者，pfADA联合pfLDH或年龄/pfADA联合pfLDH可将特异性提高到100%，而前者的敏感性较高（84.6%对76.9%）。对于>50岁的患者，pfADA联合pfN%和年龄/pfADA联合pfN%均可将特异性提高到90.3%，且敏感性相同。
尽管pfADA在NP-TPE与PPE的鉴别中起重要作用，但对于≤50岁的患者，将pfADA与pfLDH联合，或对于>50岁的患者，将pfADA与pfN%联合，可能会提高诊断性能。
