Wen Xu-Hui, Wen Jian-Xun, Mu Lan, Cao Xi-Shan, Yan Li, Huang Jin-Hong, Chen Hong, Jiang Ting-Wang, Hu Zhi-De, Niu Yan, Zheng Wen-Qi
Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China.
Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
J Thorac Dis. 2023 Dec 30;15(12):6493-6501. doi: 10.21037/jtd-23-1076. Epub 2023 Dec 6.
The diagnosis of tuberculous pleural effusion (TPE) is challenging for pulmonologists. Adenosine deaminase (ADA), interferon-gamma (IFN-γ), and interleukin-27 (IL-27) have some limitations for diagnosing TPE. Soluble Fas ligand (sFasL) had a high diagnostic value for TPE. However, it remains unknown: (I) whether sFasL has an additional diagnostic value to the traditional markers (e.g., ADA); (II) whether sFasL provides a net benefit in patients with undiagnosed pleural effusion; (III) factors affecting the diagnostic accuracy of sFasL for TPE. This study aimed to evaluate the additional diagnostic value and benefit of pleural fluid sFasL for TPE.
We prospectively enrolled 211 patients with undiagnosed pleural effusion. The concentration of sFasL in pleural fluid was measured by an enzyme-linked immunosorbent assay (ELISA). The diagnostic accuracy and net benefit of sFasL and ADA for TPE were analyzed by a receiver operating characteristic (ROC) curve, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminant improvement (IDI).
The area under the ROC curves (AUCs) of sFasL and ADA were 0.74 (95% CI: 0.65-0.83) and 0.80 (95% CI: 0.71-0.90), respectively. The decision curve of sFasL revealed net benefit. The continuous NRI and IDI of sFasL were 0.36 (0.00-0.72, P=0.05) and 0.02 (-0.01-0.06, P=0.18), respectively.
Pleural fluid sFasL has moderate diagnostic accuracy for TPE.
结核性胸腔积液（TPE）的诊断诊断对肺科医生来说诊断颇具挑战性。腺苷脱氨酶（ADA）、干扰素-γ（IFN-γ）和白细胞介素-27（IL-27）在诊断TPE方面存在一些局限性。可溶性Fas配体（sFasL）对TPE具有较高的诊断价值。然而，尚不清楚：（I）sFasL相对于传统标志物（如ADA）是否具有额外的诊断价值；（II）sFasL对未确诊胸腔积液患者是否有净效益；（III）影响sFasL诊断TPE准确性的因素。本研究旨在评估胸腔积液sFasL对TPE的额外诊断价值和效益。
我们前瞻性纳入了211例未确诊胸腔积液的患者。采用酶联免疫吸附测定（ELISA）法检测胸腔积液中sFasL的浓度。通过受试者工作特征（ROC）曲线、决策曲线分析（DCA）、净重新分类改善（NRI）和综合判别改善（IDI）分析sFasL和ADA对TPE的诊断准确性和净效益。
sFasL和ADA的ROC曲线下面积（AUC）分别为0.74（95%CI：0.65-0.83）和0.80（95%CI：0.71-0.90）。sFasL的决策曲线显示有净效益。sFasL的连续NRI和IDI分别为0.36（0.00-0.72，P=0.05）和0.02（-0.01-0.06，P=0.18）。
胸腔积液sFasL对TPE具有中等诊断准确性。
