| Objective:To explore the value of IL-22 ADA in differential diagnosis of tuberculous and non tuberculous pleural effusion.Methods:We collected 108 patients with exudative pleural effusion underwent medical thoracoscopy during October 2015 to August 2017 in the Affiliated Hospital of Hebei University.According to pathological results and exclude non compliant patients,bring 38tuberculous pleural effusion?TPE?patients,40 malignant pleural effusion?MPE?patients and26 bacterial pleural effusion?BPE?patients that be confirmed.The IL-22 concentration and ADA activity in pleural effusion were determined by enzyme-linked immuno sorbent assay?ELISA?and standard enzyme colorimetric method.Firstly,we can draw the receiver operating special characteristic curve?ROC curve?,compare the diagnostic efficiency of the index from the area under the curve.Secondly,we need measure the best diagnostic threshold and calculate the corresponding sensitivity and specificity to evaluate the diagnostic value of the detection index for the disease.Results:1.Comparison of IL-22 concentration in pleural effusions:The concentration of IL-22 in pleural effusion of three groups was compared,tuberculosis group?125.3?161.35?pg/ml?was the highest,followed by bacterial group?25.5?14.21?pg/ml?,and the last one was malignant group?14.2?17.3?pg/ml?,the difference was statistically significant?P<0.001?.The results of the special curves of the subjects?ROC curve?:The AUC of IL-22 is 0.914.The critical value of IL-22 in pleural effusion and non-tuberculous pleural effusion?bacterial group and malignant group?was 44.28pg/ml,and the corresponding sensitivity and specificity were 0.789 and 0.909 respectively.2.Comparison of ADA concentration in pleural effusion:ADA activity in tuberculosis group was 49.29±12.97U/L,significantly higher than that in tuberculosis group?14.39±7.10U/L??P<0.05?and bacterial group?25.93±14.28U/L??P<0.05?.There were 3 cases of empyema in bacterial group,if it was excluded,the activity of ADA in ibacterial group is19.45±10.48U/L,and in this condition there was no significant difference in ADA activity between ibacterial group and tuberculosis group?P>0.05?.The results of the special curves of the subjects?ROC curve?:The area under the curve of pleural effusions ADA activity was0.094,and the cut off value of pleural effusions ADA for TPE was 34.4U/L with the corresponding sensitivity and specificity 0.921 and 0.879,respectively.3.The sensitivity and specificity of parallel joint detection of pleural effusion ADA and pleural effusion IL-22 was 98.3%and 79.9%respectively.And it is with no statistically significant difference compared with each text.(?2=2.54,P=0.26,?2=3.47,P=0.18).The sensitivity and specificity of serial combined detection was 72.2%and 98.9%,respectively.It was higher with statistically significant difference compared with each text??2=5.25,P=0.01,?2=7.25,P=0.02?.Conclusions:1.The level of IL-22 in tuberculous pleural effusion is significantly higher than that in malignant and inflammatory pleural effusion,IL-22 in pleural effusion may be a new index for the differential diagnosis of tuberculous and non tuberculous pleural effusion.2.The level of ADA in tuberculous pleural effusion is significantly higher than that in malignant and bacterial pleural effusion,which can be used as the auxiliary laboratory index for diagnosis and differential diagnosis of tuberculous pleurisy.3.The combined detection of IL-22 and ADA in pleural effusion,especially the series joint detection,is more significant for the exclusion of pleural effusion,so it can be used as an auxiliary laboratory index for the diagnosis of tuberculous pleural effusion.4.For a base hospital,a hospital in which a thoracoscope has not been carried out or a patient with a thoracoscope contraindication,a patient with suspected tuberculous pleurisy,the levels of IL-22 and ADA in pleural effusion can be detected or differentiated. |
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