一种基于胸腔积液腺苷脱氨酶与血清C反应蛋白比值的评分模型，用于鉴别结核性胸腔积液与非结核性良性胸腔积液。
A scoring model based on the pleural effusion adenosine deaminase-to-serum C-reactive protein ratio for differentiating tuberculous pleural effusion from non-tuberculous benign pleural effusion.
作者信息
Hou Huan, Li Jieying, Huang Tingting, Ruan Zhaohui, Hui Xinjie, Huang Yilin, Gao Jinming
机构信息
Departments of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China.
出版信息
BMC Pulm Med. 2025 Mar 28;25(1):139. doi: 10.1186/s12890-025-03593-1.
BACKGROUND
Differentiating tuberculous pleural effusion (TPE) from non-tuberculous benign pleural effusion (non-TB BPE) can be challenging, especially in patients with low levels of pleural effusion adenosine deaminase (pADA) and negative etiological evidence. This study aimed to evaluate the diagnostic performance of the pADA to serum C-reactive protein ratio (pADA/sCRP) and to develop a scoring model for diagnosing TPE.
METHODS
This retrospective study included 364 patients with pleural effusion, comprising 121 with TPE and 243 with non-TB BPE from Peking Union Medical College Hospital. Clinical, laboratory, and imaging data were collected, and comparisons were made between the two groups. The diagnostic performance of the pADA/sCRP ratio and other statistically significant variables was assessed. Six valuable factors were selected for multivariate regression analysis to establish a predictive model, which was displayed as a nomogram.
RESULTS
The pADA/sCRP ratio demonstrated superior diagnostic performance compared to pADA alone, with an area under the curve (AUC), sensitivity, and specificity for identifying TPE of 0.68, 71%, and 64%, respectively. Six variables were selected to develop a nomogram, including night sweats, calcification on chest computed tomography, pleural effusion lymphocyte ratio, pADA/sCRP, hemoglobin, and neutrophil. With a cutoff value of 20 points, the AUC, sensitivity, and specificity for distinguishing TPE from non-TB BPE were 0.836, 83.4%, and 64.9%, respectively. The validation cohort confirmed the model with the AUC, sensitivity, and specificity of 0.815, 61.1%, and 82.4%, respectively.
CONCLUSION
The pADA/sCRP ratio exhibited improved diagnostic performance compared to pADA alone. The novel scoring system based on a nomogram demonstrated good diagnostic efficacy in differentiating TPE from non-TB BPE.
背景
鉴别结核性胸腔积液（TPE）与非结核性良性胸腔积液（非TB BPE）具有挑战性，尤其是对于胸腔积液腺苷脱氨酶（pADA）水平较低且病因学证据为阴性的患者。本研究旨在评估pADA与血清C反应蛋白比值（pADA/sCRP）的诊断性能，并建立一种诊断TPE的评分模型。
方法
这项回顾性研究纳入了364例胸腔积液患者，其中包括北京协和医院的121例TPE患者和243例非TB BPE患者。收集了临床、实验室和影像学数据，并对两组进行了比较。评估了pADA/sCRP比值及其他具有统计学意义的变量的诊断性能。选择六个有价值的因素进行多变量回归分析以建立预测模型，并以列线图的形式呈现。
结果
与单独的pADA相比，pADA/sCRP比值表现出更好的诊断性能，其用于识别TPE的曲线下面积（AUC）、敏感性和特异性分别为0.68、71%和64%。选择六个变量建立列线图，包括盗汗、胸部计算机断层扫描钙化、胸腔积液淋巴细胞比例、pADA/sCRP、血红蛋白和中性粒细胞。截断值为20分时，区分TPE与非TB BPE的AUC、敏感性和特异性分别为0.836、83.4%和64.9%。验证队列证实该模型的AUC、敏感性和特异性分别为0.815、61.1%和82.4%。
结论
与单独的pADA相比，pADA/sCRP比值的诊断性能有所提高。基于列线图的新型评分系统在鉴别TPE与非TB BPE方面显示出良好的诊断效能。
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