Pleural IFN-γ Release Assay Combined With Biomarkers Distinguished Effectively Tuberculosis From Malignant Pleural Effusion

Background:Pleural effusion(PE)is a very common disease.Because of its many and complex causes and different pathogenesis,invasive examination are often needed for diagnosis.It has been reported that tuberculosis and cancer are the two most common causes of exudative PE.Their common characteristics are with lymphocyte predominant in pleural effusion and similar biochemical and routine examination results.Early differential diagnosis is particularly important in view of the great differences in treatment and prognosis between tuberculous pleural effusion(TPE)and malignant pleural effusion(MPE).However,the use of existing biochemical indicators,such as ADA level,pleural effusion biochemical,tumor markers,etc.,for the differential diagnosis of tuberculous pleurisy and malignant pleural effusion is limited.Therefore,we need a method that can easily distinguish between the two diseases by collecting only pleural effusion without Invasive examination.Objective: To investigate the expression ofγinterferon release test of Mycobacterium tuberculosis-specific protein,IFN-γenzyme-linked immunospot assay and conventional laboratory biomarkers of pleural effusion in the differential diagnosis of tuberculous pleurisy and malignant pleural effusion.Improve the positive rate of diagnosis of tuberculous pleurisy,multi-parameter optimization of differential diagnosis of tuberculous and malignant pleural effusion.To Assess some biochemical indicators,such asthe performance of IFN-γ-ELISPOT assay、adenosine deaminase、carcinoembryonic antigen in differential diagnosis of tuberculous pleurisy and cancerous pleural effusion in routine laboratory biomarkers.Methods: Analysis of 201 patients with pleural effusion admitted to Shenzhen Third People’s Hospital from January 2010 to December 2016(A total of 143 patients diagnosed with tuberculous pleurisy;58 patients diagnosed with malignant pleural effusion).The levels ofγinterferon in the blood and pleural effusion of Mycobacterium tuberculosis-specific protein were measured in patients with pleural effusion,and the results of pleural effusion ADA and CEA were statistically analyzed,ROC analysis was performed to obtain the best cutoff value of ADA and CEA for detecting tuberculous pleurisy.Results:(1)The results of this analysis suggest that the CEA value of malignant pleural effusion is significantly higher than that of tuberculous pleurisy.The area under the ROC curve analysis curve(AUC)is 0.9713,which is used for the diagnosis of malignant pleural effusion.The statistical data of this study is cut-off.The value of 2.025 ng / L,CEA detection of pleural effusion diagnosis of malignant pleurisy is the best sensitivity and specificity.The ADA detected in the pleural effusion of patients with tuberculous pleural effusion was significantly higher than that of the malignant pleural effusion group,and the difference was statistically significant.With a cut-off value of 35 U/L,ADA has a high sensitivity and specificity for the diagnosis of tuberculous pleurisy with pleural effusion.The area under the AUC curve is 0.9585,suggesting that ADA in pleural effusion is sensitive to tuberculous pleurisy.(2)The level of IFN-γ-ELispot in patients with tuberculous pleural effusion was significantly higher than that in the malignant pleural effusion group by ESAT-6 protein and peptide peptide in plasma and pleural effusion.The difference was statistically significant(P<0.0001).The value of antigen-specific IFN-spotting cells(SFC)in PFMC stimulated with ESAT-6 protein and peptid-pool peptide is about 2-4 times that of peripheral blood mononuclear cells from the same TPE patient.(ROC)analysis demonstrated that the area under the curve(AUC)of the pleural effusion monocyte ELISPOT assay was higher than the PBMC ELISPOT assay;both indicated that the diagnostic efficacy of PFMC ELISPOT for the diagnosis of tuberculous pleurisy was higher than that of the PBMC ELISPOT assay.(3)The combined ELISPOT test and ADA combined diagnosis of tuberculous pleurisy increased the specificity to 28.5% by 28.1%,and the PPV increased to 98.3% at the same time,which was significantly increased,The difference was statistically significant.Similarly,pleural effusion IFN-γ-ELispot combined with CEA to diagnose the specificity of MPE,PPV is also better than non-combined diagnosis,but the sensitivity is slightly lower(87.1% vs 99.3%,the difference is not statistically significant),meaning tuberculous pleurisy In the differential diagnosis of malignant pleural effusion,the combination of IFN-γ-ELispot with ADA and CEA can significantly improve the diagnostic efficiency.(4)Patients with tuberculous pleurisy who underwent thoracoscopic examination were further divided into pleural adhesion group and non-adhesive group.Comparing the biochemical indicators of pleural effusion,the ADA value and LHD value of pleural adhesion group were higher than those of pleural non-adhesion group.The difference was statistically significant.Conclusion:(1)Using pleural effusion IFN-γ-ELispot examination to diagnose tuberculous pleurisy better than peripheral blood IFN-γ-ELispot;(2)IFN-γ-ELispot and pleural effusion ADA values of Mycobacterium tuberculosis-specific proteins are used to diagnose tuberculous pleurisy with high sensitivity and specificity;CEA value is used to diagnose malignant pleurisy with high specificity;Combined pleural effusion IFN-γ-ELispot,ADA value can significantly improve the diagnostic positive rate of tuberculous pleurisy.Combined pleural effusion IGRA,ADA,CEA values for differential diagnosis of tuberculous pleurisy and malignant pleural effusion.(3)Patients with tuberculous pleurisy with pleural adhesion have high ADA and LDH values,which can be used to determine the severity of pleural thickening in tuberculous pleurisy.The results of pleural effusion IFN-Y-ELispot were stable and were not affected by the degree of pleural adhesion.