Research On Index In Pleural Fluid Of Tuberculous Pleurisy Dignosed By Medical Thoracoscope And Guidance In Clinic

Purpose:To make sense of the range of indexes, including ADA, LDH, CA125, karyocyte numbers, ratio of monocyte in pleural effusion of patients diagnosed with tuberculosis pleuritis, further explore their significance for diagnosis in clinic, and in order to act as guidance to clinical treatmentMethods:Retrospective analysis is used in our experiment. We collect basic materials of 191patients in east branch of Shandong Provincial Hospital,while 60 tuberculosis pleuritis,89 malignant pleuritis,22 empyema and 20 other diseases. Patients feel oppression in chest and asthma before coming and they are diagnosed pleural effusion with the help of CT or X-ray. They were performed thoracoscope in hospital for biopsy and acid fast stain for diagnosis. Then thoracical puncturing and chest drainage is applied. Through examination of pleural fluid, we can get numbers of indexes, including ADA, LDH, CA125, karyocyte numbers and ratio of monocyte. Calculate their respective range and compare them with other groups, including cancers and empyema. Figure out whether they have statistical significance. Then, ROC curve is helpful in finding their respective critical value in diagnosing tuberculosis pleuritis.Results:In tuberculosis pleuritis group, average ADA is 40.50±21.60U/L, while that in malignant group and empyema group is 15.24±21.31、87.31±49.76U/L, the tuberculosis group has statistical difference with other groups. (P<0.05) In tuberculosis pleuritis group, average CA125 is 459.87±469.59U/mL, while that in malignant group and empyema group is 877.33±867.07mU/L、77.82±92.98mU/L, the tuberculosis group has statistical difference with both groups (P<0.05).In tuberculosis pleuritis group, average LDH is 373.74±179.99U/L, while that in malignant group and empyema group is 383.18±240.18、4683.22±2129.10U/L, the tuberculosis group only has statistical difference with empyema group (P<0.01).In tuberculosis pleuritis group, average karyocyte number is 2575.49±1852.70/L, while that in malignant group and empyema group is 1939.89+1793.26,72515.6± 16476.36/L, the tuberculosis group only has statistical difference with empyema group (P<0.01).In tuberculosis pleuritis group, average ratio of monocyte is 87.03± 23.33%, while that in malignant group, empyema group is 71.76±27.06%, 6.80±8.54%, the tuberculosis group has statistical difference with both groups(P<0.01). As in showed by ROC curve, the critical value of ADA in diagnosing tuberculosis pleuritis is 18.3U/L, sensitivity is 91.5%, specificity is 73.9%, Youden index is 0.654. The critical value of CA125 in diagnosing tuberculosis pleuritis is 637.15U/mL, sensitivity is 45.5%, specificity is 58.1%, Youden index is 0.036. The critical value of LDH in diagnosing tuberculosis pleuritis is 111U/L, sensitivity is 100%, specificity is 8%, Youden index is 0.082. The critical value of karyocyte number in diagnosing tuberculosis pleuritis is 1827.5/L, sensitivity is 71%, specificity is 48.5%, Youden index is 19.6%. The critical value of rate of monocyte in diagnosing tuberculosis pleuritis is 93.4%, sensitivity is 67%, specificity is 89%, Youden index is 0.558, shows its significance in clinic.Conclusion:ADA and monocyte ratio serve as important referential indexes in distinguishing tuberculosis pleuritis and other diseases such as malignant pleuritis and empyema. Their critical values are 18.3 U/L and 93.4%. CA125 can distinguish them,but the critical value has no meaning. LDH can distinguish tuberculosis pleuritis and empyema, karyocyte number have little significance in distinguishing the groups in clinic, and both of their critical value have no meaning.