Lei Xiaoli, Wang Junli, Yang Zhigang
Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Cardiopulmonary Function, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China.
Front Med (Lausanne). 2021 Mar 18;8:639061. doi: 10.3389/fmed.2021.639061. eCollection 2021.
Tuberculous pleurisy (TBP) is a common clinical type of tuberculosis (TB) in China. TBP is difficult to diagnose. Whether the mononuclear cell/leukocyte (MNC/LEU) ratio in pleural effusion can contribute to accurate TBP diagnosis remains yet unclear. To explore the diagnostic value of MNC/LEU ratio in pleural effusion for TBP in China. This study was a retrospective case-control study involving 406 patients with pleural effusion of unknown cause who were hospitalized at the Henan Provincial People's Hospital. Using histopathological examination of thoracoscopic pleural biopsy as the gold standard for TBP diagnosis, a final total of 215 subjects were included in this study including 91 cases of TBP and 124 cases of non-TBP. The receiver operating characteristic (ROC) curve of pleural effusion MNC/LEU ratio for TBP diagnosis was plotted and the area under curve (AUC) and the optimal cutoff value were determined. In addition, the sensitivity, specificity and accuracy of the MNC/LEU ratio at the optimal cutoff value for TBP diagnosis were also evaluated. The MNC/LEU ratio was significantly higher in TB pleural effusion [95.9% (89.7-98.0%)] than in non-TB pleural effusion [77.8% (39.3-93.2%)] ( < 0.001). The AUC was 0.776 (95% CI, 0.714-0.830), and the sensitivity, specificity and accuracy for TBP diagnosis at the 93.7% cutoff value were 64.83%, 79.03%, and 0.730, respectively. The pleural effusion MNC/LEU ratio may be a new and valuable laboratory indicator for the diagnosis of tuberculous pleurisy in China.
结核性胸膜炎（TBP）是中国结核病（TB）常见的临床类型。TBP诊断困难。胸腔积液中单核细胞/白细胞（MNC/LEU）比值是否有助于准确诊断TBP尚不清楚。为探讨中国胸腔积液中MNC/LEU比值对TBP的诊断价值。本研究为回顾性病例对照研究，纳入河南省人民医院收治的406例不明原因胸腔积液患者。以胸腔镜胸膜活检组织病理学检查作为TBP诊断的金标准，最终共纳入215例受试者，包括91例TBP患者和124例非TBP患者。绘制胸腔积液MNC/LEU比值诊断TBP的受试者工作特征（ROC）曲线，确定曲线下面积（AUC）及最佳截断值。此外，还评估了最佳截断值时MNC/LEU比值对TBP诊断的敏感性、特异性和准确性。结核性胸腔积液的MNC/LEU比值[95.9%（89.7 - 98.0%）]显著高于非结核性胸腔积液[77.8%（39.3 - 93.2%）]（<0.001）。AUC为0.776（95%CI，0.714 - 0.830），截断值为93.7%时，对TBP诊断的敏感性、特异性和准确性分别为64.83%、79.03%和0.730。胸腔积液MNC/LEU比值可能是中国诊断结核性胸膜炎的一项新的有价值的实验室指标。
