The Value Of Pleural Tissue Xpert MTB/RIF In The Diagnosis Of Tuberculous Pleurisy Under Thoracoscopic Surgery

Background:Tuberculous pleurisy is a pleural exudative inflammation caused by the invasion of pleural cavity by Mycobacterium tuberculosis(MTB).The onset of the disease is hidden,the course of the disease is long,and there is no specific clinical diagnosis at present,so it is easy to be misdiagnosed and missed.Medical thoracoscopy can obtain tissue samples from the chest cavity under direct vision to assist in diagnosis,but it takes a long time to rely on pathological examination.Xpert MTB/RIF was first recommended by World Health Organization(WHO)in 2010 for early detection of pulmonary tuberculosis.It can detect the presence of MTB in samples within 2 hours.At present,it is widely used in the diagnosis of various tuberculosis.Although it is clinically found that the method of collecting pleural effusion samples for Xpert MTB/RIF detection(pleural effusion Xpert MTB/RIF)can be used for the diagnosis of tuberculous pleurisy,but the defect of this method is that the sensitivity is low,so the diagnostic value is low.It is worth noting that many studies have shown that Xpert MTB/RIF examination of pleural tissue under thoracoscopic surgery may have higher sensitivity.Objective:Cases were collected and the sensitivity and specificity of pleural tissue Xpert MTB/RIF in the diagnosis of tuberculous pleurisy were calculated,and compared with the sensitivity and specificity of pleural pathological examination,pleural effusion Xpert MTB/RIF,pleural tissue acid-fast staining,ADA,in order to explore the value of pleural Xpert MTB/RIF in the diagnosis of tuberculous pleurisy.Methods:A total of 95 patients who were examined by thoracoscopy,pleural histopathology,pleural tissue Xpert MTB/RIF,pleural effusion Xpert MTB/RIF,pleural effusion routine,pleural effusion biochemistry and hydrothorax acid resistance were included.The observation indicators include: the sensitivity and specificity of using Xpert MTB/RIF technique of pleural tissue under medical thoracoscope alone and combined with different testing methods in the diagnosis of tuberculous pleurisy.Statistical analysis: all the data in this study were analyzed by SPSS 26.0 statistical software.P < 0.05 indicates that this difference is statistically significant.The measurement data were expressed by mean ±standard deviation,independent sample t test was used for pairwise comparison,single factor analysis of variance(One-Way ANOVA)was used for multi-group comparison,counting data was expressed by rate(%),and chi-square test was used for comparison between groups.Results:A total of 95 patients who met the inclusion criteria were included in this study,of which 43(45.3%)were diagnosed as tuberculous pleurisy,36(37.9%)as malignant pleural effusion,and 16(16.8%)patients as parapneumonic effusion and others.The results showed that the sensitivity and specificity of pleural effusion Xpert MTB/RIF in the diagnosis of tuberculous pleurisy were 9.3% and 100% respectively;the sensitivity and specificity of pleural Xpert MTB/RIF in the diagnosis of tuberculous pleurisy were 88.4% and 100% respectively;and the sensitivity and specificity of pleural histopathological examination in the diagnosis of tuberculous pleurisy were90.7% and 100% respectively.Xpert MTB/RIF and pathological examination of pleural tissue under medical thoracoscope were consistent in the diagnosis of tuberculous pleurisy(Kappa=0.847,P < 0.05).The sensitivity and specificity of pleural Xpert MTB/RIF combined with pleural histopathology in the diagnosis of tuberculous pleurisy were 97.7% and 100%,respectively.Conclusion:1.Pleural tissue Xpert MTB/RIF has a high sensitivity(88.4%)and specificity(100%)in the diagnosis of tuberculous pleurisy.Compared with pleural pathological examination,pleural tissue Xpert MTB/RIF has a good consistency(Kappa=0.847,P< 0.05),and has high diagnostic value.2.Pleural fluid Xpert MTB/RIF had low sensitivity(9.3%),specificity(100%)and diagnostic value in the diagnosis of tuberculous pleurisy.3.Thoracoscopic pleural Xpert MTB/RIF combined with pleural histopathology can improve the sensitivity(97.7%)and specificity(100%)in the diagnosis of tuberculous pleurisy.