| Background and Purpose:In China, tuberculous pleurisy is common extra pulmonary tuberculosis, is also the most common cause of pleural effusion, pleural effusion according to statistics accounted for more than half. Clinical work is mainly based on "bacteriology and histopathology" to check tuberculous pleurisy. However, the positive rate of pleural effusion TB smear and culture is low, and some patients do not want to accept thoracoscopy pleural biopsy because it is an invasive examination. PPD test is the traditional method for diagnosis of tuberculosis, but it is susceptible to be affected by the Bacillus Calmette-Guerin(BCG) vaccination and immune system. Adenosine deaminase(ADA) is a common indicators of clinical diagnosis of tuberculous pleurisy, but the lymphoma and empyema also lead to the ADA activity increased. T-SPOT.TB has been widely used to clinically diagnosis of tuberculosis because of its high sensitivity and specificity, but a number of factors can lead to T-SPOT.TB false negative test results. More and more studies have shown that for diagnosis of tuberculous pleurisy many markers are greater value than the single detection. This study aimed to explore T-SPOT.TB, pleural effusion ADA, PPD single and combined assay value in tuberculous pleural effusion diagnosis, to find a fast, sensitive and accurate clinical diagnostic method. Materials and Methods:A total 151 patients with pleural effusion were collected from Henan Provincial Chest Hospital Respiratory Medicine from February 2015 to January 2016. of those, 99 patients had tuberculous pleural effusion, 54 males and 45 females, the mean age was 31.97±15.89, 52 patients had non-tuberculous pleural effusion, 27 males and 25 females, the mean age was 51.83±15.08. For all patients with PPD test, peripheral blood T-SPOT.TB testing and pleural effusion ADA activity determination; and another 16 cases of tuberculous pleural effusion patients with pleural effusion T-SPOT.TB test. To compare T-SPOT.TB, pleural effusion ADA, PPD three methods individually and combined for diagnosis of tuberculous pleurisy, and compared the activity of pleural effusion ADA between the two groups. Data analyses were performed by using the SPSS software package version 17.0. Statistical methods used chi-square test and t test. All statistical analyzes were α= 0.05 level for the test standard, and P<0.05 was considered to be statistically significant. Sensitivity = positive patients with tuberculous pleural effusion / total number of tuberculous pleural effusion; Specificity = negative patients of non-tuberculous pleural effusions / total number of non-tuberculous pleural effusion; Accuracy = number of positive tuberculous pleural effusions + non-tuberculous pleural effusions negative number / total number. Results:(1) The methods of peripheral blood T-SPOT.TB, pleural effusion ADA and PPD to test tuberculous pleural effusion pateints of positive rate(T-SPOT.TB: 80.8%, ADA: 75.8%, PPD: 66.7%) was significantly higher than that of non-tuberculous pleural effusion group(T-SPOT.TB: 11.5%, ADA: 19.2%, PPD: 38.5%), the differences were statistically significant(T-SPOT.TB:χ2=66.7,P=0.000;ADA:χ2= 44.3,P=0.000;PPD:χ2= 19.6,P=0.000). Tuberculous pleural effusion group ADA activity was 48.11±50.72U/L, the group of non-tuberculous pleural effusion ADA activity was 20.40±17.93U/L, the former was significantly higher than the latter( t = 3.811, P = 0.000). The sensitivity(80.8%) and specificity(88.5%) of peripheral blood T-SPOT.TB diagnosis of tuberculous pleurisy was the best; followed by pleural effusion ADA( sensitivity 75.8%, specificity 80.8%); PPD was relatively poor(sensitivity 66.7%, specificity 61.5%). To test tuberculous pleural effusion, the sensitivity and specificity of peripheral blood T-SPOT.TB compared to PPD, the differences were statistically significant(χ2=5.112, P=0.024; χ2=10.05, P=0.002); but compare with ADA, the differences were no statistically significant(χ2=0.743, P=0.389; χ2=1.182, P=0.277). ADA compared to PPD, the differences of sensitivity were no statistically significant(χ2=1.996, P=0.158), but the differences of specificity were statistically significant(χ2=4.658, P=0.030).(3) The pleural effusion T-SPOT.TB and blood T-SPOT.TB diagnosis of tuberculous pleural effusion sensitivity was 100%, 87.5%, respectively, and the differences were no statistically significant(χ2=2.133, P=0.1444). But the pleural effusion T-SPOT.TB test wells were significantly higher than the number of positive spots of blood T-SPOT.TB test results.(4) In a parallel joint detection, the sensitivity of blood T-SPOT.TB or pleural effusion ADA or PPD diagnosis of tuberculous pleural effusion was the highest(98.0%) compared to pleural effusion ADA or PPD and blood T-SPOT.TB or PPD(90.9%), the differences were statistically significant(χ2=4.717, P=0.030); compare to the sensitivity of blood T-SPOT.TB or pleural effusion ADA(97.0%), the differences were no statistically significant(χ2=0.205, P=0.651); the sensitivity of blood T-SPOT.TB or pleural effusion ADA compared to the blood T-SPOT.TB or PPD and pleural effusion ADA or PPD, the differences were no statistically significant(χ2=3.194,P=0.074). The specificity of the blood T-SPOT.TB or pleural effusion ADA(76.9%) compared with he blood T-SPOT.TB or pleural effusion ADA or PPD(57.7%), the differences were statistically significant(χ2=4.370, P=0.037). Comparison the remaining specificity between the two, the differences were no statistically significant(P>0.05). The accuracy of blood T-SPOT.TB or pleural effusion ADA diagnosis of tuberculous pleurisy was the highest(90.1%), compare to blood T-SPOT.TB or PPD(80.8%), the differences were statistically significant(χ2=5.214, P=0.022); compared to pleural effusion ADA or PPD(80.1%), the differences were statistically significant(χ2=5.875,P=0.015). Four kinds of parallel joint detection method, the overall effect of T-SPOT.TB blood and pleural effusion ADA joint diagnosis of tuberculous pleurisy was best.(5) In a series of joint detection: a series of three detection methods for diagnosing tuberculosis pleural effusion highest specificity was 100%, compared with the combination of pleural effusion ADA and PPD specificity was 92.3%, the difference was statistically significant(χ2=4.160, P=0.041); but compare with blood T-SPOT.TB and pleural effusion ADA(96.2%) and with blood T-SPOT.TB and PPD(94.2%), the difference was no statistically significant(P>0.05). Comparison the remaining specificity between the two, the differences were no statistically significant(P>0.05). The sensitivity of blood T-SPOT.TB and pleural effusion ADA(64.6%) was highest, compare with blood T-SPOT.TB and PPD(49.5%), with blood T-SPOT.TB and pleural effusion ADA and PPD(41.4%), the differences of groups compare were statistically significant(χ2=4.638, P=0.031; χ2=6.561, P=0.010). But compare with pleural effusion ADA and PPD(52.5%), the differences of groups compare were statistically significant(χ2=2.997, P=0.083).Comparison the remaining sensitivity between the two, the differences were no statistically significant(P>0.05). The accuracy of blood T-SPOT.TB or pleural effusion ADA diagnosis of tuberculous pleurisy was the highest(75.5%), compare with blood T-SPOT.TB and pleural effusion ADA and PPD, the differences were statistically significant(χ2=6.773,P=0.009), compare with blood T-SPOT.TB and PPD, the differences were statistically significant(χ2=4.052,P=0.044). Four kinds of series joint detection method, the overall effect of T-SPOT.TB and pleural effusion ADA joint diagnosis of tuberculous pleurisy was best. Conclusion:(1) Peripheral blood T-SPOT.TB, pleural effusion ADA for auxiliary diagnosis of tuberculous pleural effusion had more value than PPD.(2) The value of pleural effusion T-SPOT.TB diagnosed tuberculous pleural effusion may had more value than peripheral blood T-SPOT.TB.(3) The sensitivity and specificity of combined detection can significantly improve than the single detection, reducing missed diagnosis and misdiagnosis which of the T-SPOT.TB combined with effusion ADA was best. |
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