Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose City, Tokyo, 204-8522, Japan; Department of Respiratory Medicine, Kyorin University Faculty of Medicine, Mitaka City, Tokyo, 181-8611, Japan.
Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose City, Tokyo, 204-8522, Japan.
Respir Investig. 2024 Nov;62(6):963-969. doi: 10.1016/j.resinv.2024.08.010. Epub 2024 Aug 25.
Adenosine deaminase (ADA) in pleural fluid is a useful marker for diagnosing tuberculous pleurisy. However, recent studies have reported a lower specificity of pleural fluid ADA levels. We previously developed a diagnostic flowchart for patients with pleural fluid ADA ≥40 U/L, incorporating variables such as pleural fluid lactate dehydrogenase <825 U/L, predominant pleural fluid neutrophils or cell degeneration, and a pleural fluid ADA/total protein ratio <14. This flowchart was effective in distinguishing between tuberculous pleurisy and other diseases. Here, we conducted a validation analysis of this flowchart.
We retrospectively collected data from 458 patients with pleural fluid ADA concentrations ≥40 U/L across eight institutions from January 2019 to December 2023. The diagnostic accuracy rate, sensitivity, and specificity of the diagnostic flowchart were analysed and compared to those in the original study.
Eighty-seven patients were diagnosed with tuberculous pleurisy, and 371 patients were diagnosed with other diseases. The diagnostic accuracy, sensitivity, and specificity for diagnosing tuberculous pleurisy were 77.7%, 86.2%, and 75.7%, respectively. Compared with that in the original study, the rate of tuberculous pleurisy was lower (19.0% vs. 44.5%, p < 0.001), but the diagnostic accuracy rates were not significantly different (p = 0.253). On the basis of the findings from this validation study, we have revised the flowchart to enhance its utility.
The diagnostic flowchart exhibited high diagnostic accuracy in this validation study, comparable to that in the original study. This validation confirms the effectiveness of the flowchart, even in settings with a low incidence of tuberculosis.
胸腔积液中的腺苷脱氨酶（ADA）是诊断结核性胸膜炎的有用标志物。然而，最近的研究报告称胸腔积液 ADA 水平的特异性较低。我们之前开发了一个诊断流程图，用于胸腔积液 ADA≥40U/L 的患者，该流程图纳入了胸腔积液乳酸脱氢酶<825U/L、主要胸腔液中性粒细胞或细胞变性以及胸腔液 ADA/总蛋白比值<14 等变量。该流程图在区分结核性胸膜炎和其他疾病方面非常有效。在这里，我们对该流程图进行了验证分析。
我们回顾性地收集了来自 8 家机构的 458 名胸腔积液 ADA 浓度≥40U/L 的患者的数据，这些患者的就诊时间为 2019 年 1 月至 2023 年 12 月。分析并比较了诊断流程图的诊断准确率、敏感性和特异性，以及与原始研究中的结果。
87 名患者被诊断为结核性胸膜炎，371 名患者被诊断为其他疾病。诊断结核性胸膜炎的准确性、敏感性和特异性分别为 77.7%、86.2%和 75.7%。与原始研究相比，结核性胸膜炎的发生率较低（19.0% vs. 44.5%，p<0.001），但诊断准确率无显著差异（p=0.253）。基于这项验证研究的结果，我们对流程图进行了修订，以提高其效用。
在这项验证研究中，诊断流程图表现出了很高的诊断准确性，与原始研究相当。这项验证证实了该流程图的有效性，即使在结核病发病率较低的情况下也是如此。
