Xi'an Chest Hospital, Xi'an 710000, Shaanxi Province, China.
Medicine (Baltimore). 2022 Jul 1;101(26):e29788. doi: 10.1097/MD.0000000000029788.
Most of pleural effusions are caused by tuberculosis and malignant tumor. Difficult sampling and bacterial sparing nature of these diseases challenge doctors' diagnosis in China. This study aimed to develop a new convenient and effective method for the differentiation of tuberculous and malignant pleural effusion. A prospective cohort study of patients hospitalized with malignant (n = 90) and tuberculous (n = 130) pleural effusions from September 2018 to October 2020 was performed. The diagnostic performance of the age to pleural fluid ADA ratio (age/ADA) and other indicators to distinguish tuberculous and malignant pleural effusions was evaluated by receiver operating characteristic (ROC) curve analysis. The areas under the curve (AUC) of age/ADA and pleural fluid ADA were largest. Age/ADA showed sensitivity and specificity of 81.5% (95%CI 73.8%-87.8%) and 97.8% (95%CI 92.2%-99.7%) respectively. The sensitivity and specificity of pleural fluid ADA were 83.1% (95%CI 75.5%-89.1%) and 93.3% (95%CI 86.1%-97.5%) respectively. The positive likelihood [36.69 (95%CI 9.3-144.8)] of age/ADA was significantly higher than that of pleural fluid ADA [12.46 (95%CI 5.7-27.1)]. The AUCs for Cancer Ratio and Cancer Ratio plus were lower and showed a sensitivity of 80.0% (95%CI 72.1%-86.5%), 80.0% (95%CI 70.2%-87.7%) and a specificity of 81.5% (95%CI 73.8%-87.8%), 80.0% (95%CI 70.2%-87.7%) respectively. Age/ADA has a higher diagnostic accuracy than ADA. Age/ADA is a promising diagnostic index for tuberculous and malignant pleural effusion with high sensitivity and specificity, especially the high positive likelihood ratio. The diagnostic accuracy of Cancer Ratio and Cancer Ratio plus are inferior to those of age/ADA and ADA.
大多数胸腔积液是由肺结核和恶性肿瘤引起的。在中国，这些疾病的采样困难和细菌稀少性给医生的诊断带来了挑战。本研究旨在开发一种新的方便有效的方法来区分结核性和恶性胸腔积液。对 2018 年 9 月至 2020 年 10 月因恶性胸腔积液（n=90）和结核性胸腔积液（n=130）住院的患者进行了前瞻性队列研究。通过受试者工作特征（ROC）曲线分析评估了年龄与胸腔积液 ADA 比值（年龄/ADA）和其他指标区分结核性和恶性胸腔积液的诊断性能。年龄/ADA 和胸腔积液 ADA 的曲线下面积（AUC）最大。年龄/ADA 的敏感性和特异性分别为 81.5%（95%CI 73.8%-87.8%）和 97.8%（95%CI 92.2%-99.7%）。胸腔积液 ADA 的敏感性和特异性分别为 83.1%（95%CI 75.5%-89.1%）和 93.3%（95%CI 86.1%-97.5%）。年龄/ADA 的阳性似然比[36.69（95%CI 9.3-144.8）]明显高于胸腔积液 ADA 的阳性似然比[12.46（95%CI 5.7-27.1）]。Cancer Ratio 和 Cancer Ratio plus 的 AUC 较低，敏感性分别为 80.0%（95%CI 72.1%-86.5%）、80.0%（95%CI 70.2%-87.7%），特异性分别为 81.5%（95%CI 73.8%-87.8%）、80.0%（95%CI 70.2%-87.7%）。年龄/ADA 的诊断准确性高于 ADA。年龄/ADA 是一种有前途的结核性和恶性胸腔积液诊断指标，具有较高的敏感性和特异性，尤其是较高的阳性似然比。Cancer Ratio 和 Cancer Ratio plus 的诊断准确性低于年龄/ADA 和 ADA。
