Shi Xin-Yu, Zhang Yi-Xiao, Dong Shu-Feng, Chen Qing-Yu, Yi Feng-Shuang
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Beijing, China.
J Thorac Dis. 2025 Aug 31;17(8):5777-5786. doi: 10.21037/jtd-2024-2295. Epub 2025 Aug 28.
In regions with a high prevalence of tuberculosis, it is crucial to accurately differentiate between tuberculosis pleural effusion (TPE) and parapneumonic effusion (PPE). The current study aimed to evaluate the potential role of the pleural fluid lactate dehydrogenase (LDH)/adenosine deaminase (ADA) ratio in differentiating between TPE and PPE.
In the first section, the pleural fluid LDH/ADA ratio was compared between 45 patients with TPE and 81 patients with PPE within our study population, and its diagnostic efficacy was assessed. In the second section, we conducted a meta-analysis incorporating six previous publications and the current study.
In our study population, a cut-off value of 18.63 for the pleural fluid LDH/ADA ratio was established for diagnostic performance analysis. The area under the curve (AUC) to discriminate between TPE and PPE was 0.960 [95% confidence interval (CI): 0.902 to 0.989]. As for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value and negative predictive value, they were 94.44% (95% CI: 81.3% to 99.3%), 84.85% (95% CI: 73.9% to 92.5%), 6.23 (95% CI: 3.50 to 11.09), 0.065 (95% CI: 0.017 to 0.25), 77.3% (95% CI: 65.6% to 85.8%), and 96.6% (95% CI: 87.9% to 99.1%), respectively. The diagnostic accuracy of the pleural fluid LDH/ADA ratio was further tested and confirmed in the subsequent meta-analysis. The meta-analysis demonstrated that the pooled sensitivity and specificity were 90% (95% CI: 82% to 94%) and 91% (95% CI: 84% to 95%), respectively.
The current study suggests that the pleural fluid LDH/ADA ratio is a useful marker for distinguishing TPE from PPE.
在结核病高流行地区，准确区分结核性胸腔积液（TPE）和类肺炎性胸腔积液（PPE）至关重要。本研究旨在评估胸腔积液乳酸脱氢酶（LDH）/腺苷脱氨酶（ADA）比值在区分TPE和PPE中的潜在作用。
在第一部分中，比较了本研究人群中45例TPE患者和81例PPE患者的胸腔积液LDH/ADA比值，并评估其诊断效能。在第二部分中，我们进行了一项荟萃分析，纳入了之前的六篇出版物和本研究。
在我们的研究人群中，确定胸腔积液LDH/ADA比值的截断值为18.63用于诊断性能分析。区分TPE和PPE的曲线下面积（AUC）为0.960 [95%置信区间（CI）：0.902至0.989]。至于敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、阳性预测值和阴性预测值，它们分别为94.44%（95% CI：81.3%至99.3%）、84.85%（95% CI：73.9%至92.5%）、6.23（95% CI：3.50至11.09）、0.065（95% CI：0.017至0.25）、77.3%（95% CI：65.6%至85.8%）和96.6%（95% CI：87.9%至99.1%）。胸腔积液LDH/ADA比值的诊断准确性在随后的荟萃分析中得到进一步检验和证实。荟萃分析表明，合并敏感性和特异性分别为90%（95% CI：82%至94%）和91%（95% CI：84%至95%）。
本研究表明，胸腔积液LDH/ADA比值是区分TPE和PPE的有用标志物。
