The Diagnosis Evaluation Of Pleural Tuberculosis Using Multiple Index And UPLS-MS

Part I The combined detection of ADA, TB-in DNA and γ-IFN value in the diagnosis of tuberculous pleurisyObjective:Detection of adenosine deaminase, TB-DNA and γ-IFN was applied in the detect of tuberculous pleural effusion, three alone or combined detect in diagnosis of tuberculous pleural effusion was discussed to provide clinical basis for a practical, reliable and simple diagnostic method.Methods:43cases of pleurisy specimens in patients with tuberculous pleurisy was collected from2012November to2013July in Department of tuberculosis of Tianjin Haihe Hospital.3methods for the detection of sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy (CA), Youden index for the evaluation, are combined in parallel and series detection in diagnosis evaluation.Result:In the parallel test, ADA or γ-IFN sensitivity was the highest which had no significant difference with TB-DNA or γ-IFN combination (P>0.05), and there’s a significant difference between the ADA or TB-DNA. TB-DNA or γ-IFN combination had the highest specificity (94.27%), with a significant difference between the other two (P<0.05). In a series of trials, there was no significant difference between the2methods combined detection specificity (P>0.05), ADA and γ-IFN combination of sensitivity was the highest with a significant difference between the other two.the detection of3methods was higher than2combined detection which had the highest specificity (99.98%). Conclusion:The detection of ADA, TB-DNA and γ-IFN in Pleural effusion can not be taken as the most effective method for diagnosis of tuberculous pleurisy, which is just an auxiliary method in the diagnosis of tuberculous pleurisy. The results of any2of the combined detection in the positive detection rate was significantly higher than that of single detection method, and the sensitivity and specificity were greatly improved. The sensitivity and specificity of combined detection of3kinds of method is higher than that of2; the positive rate of traditional method is low, the culture process was long, combined detection which can greatly improve the sensitivity in the diagnosis of tuberculous pleurisy has high clinical value in the diagnosis of tuberculous pleural effusion,It is a rapid, accurate, effective experimental method in the diagnosis of tuberculous pleural. Part Ⅱ The diagnosis evaluation of pleural tuberculosis based on UPLS-MSObjective:Use ultra performance liquid chromatography-mass spectrometry (UPLC-MS) analysis system in patients with tuberculous pleurisy to discover potential metabolic biomarkers in the early diagnosis of tuberculous pleurisy.Methods:Collect pleural samples from43cases of pleural tuberculosis patients which from November2012to July2013in tuberculosis department of HaiHe hospital.The measured data was imported into MZmine2.0software, and the processed data will be imported into SIMCA-P+12.0.1.0(Sweden Umetrics company) for analysis. Build the orthogonal partial least squares discriminant analysis (OPLS-DA) model through pattern recognition method by SIMCA-P+12.0.1.0.Besides potential biomarkers was filtered preliminary by VIP and VIP confidence interval value that implement non-parametric test on variables from independent samples using SPSS15.0(SPSS, USA) to exclude variables with p>0.05.Results:1.Based on the data of metabolites in patients with tuberculous pleurisy, the OPLS-DA model could be good enough to distinguish the lung cancer and transudate.2.Through the screening of potential metabolites,46of them was finally selected and6metabolites was identified.1metabolites was decreased while5increased in the diagnosis of tuberculous pleurisy.3.27-Deoxy-5b-cyprinol,L-Phenylalanine,13’-hydroxy-alpha-tocotrienol, lysophosphatidic metabolites were expected to become more effective in diagnosis and antidiastole of tuberculous pleurisy.Conclusion:The core concepts of metabolomics is considered that The metabolic status of the individual can be able to reflect their Health status very closely, this metabolic state is resulted from double role of genome encodes and environmental modification.In this study, a ultra performance liquid chromatography mass spectrometry analysis (UPLC-MS) was used for the patients with tuberculous pleurisy, and initially screened and identified a total of46metabolic markers. Further studies showed that6metabolites were significant difference which would be metabolomic markers. The results show that the OPLS-DA model Constructed by pleural metabolic profiling can distinguish well between the lung cancer and transudate. The results of this search have provided new ideas and methods for biomarkers of tuberculous pleurisy in the early diagnosis of tuberculous pleurisy.