The Differential Diagnostic Value Of Heparin-binding Protein In Parapneumonic Effusions

Objective1.To detect the expression level of heparin-binding protein in pleural effusions of patients with pleural effusion,and evaluate the value of heparin-binding protein(HBP)in differential diagnosis of parapneum effusion(PPE)in patients with pleural effusion.2.Detection of pleural effusion lactate dehydrogenase(LDH),adenosine deaminase(ADA),C-reactive protein(CRP)and serum C-reactive protein in patients with pleural effusion And compare the diagnostic efficacy of pleural effusion heparin-binding protein,lactate dehydrogenase,adenosine deaminase,C-reactive protein and serum C-reactive protein in the differential diagnosis of pneumonia pleural effusion.3.To evaluate the clinical value of pleural effusion HBP level in the differential diagnosis of parapneumonic pleural effusion and tuberculous pleural effusion.4.To investigate the relationship between pleural effusion HBP and pleural effusion polymorphonuclear cell count.Methods1.Retrospective case-control study.The pleural effusion specimens of 189 patients with pleural effusion admitted to the Quzhou People's Hospital from February to August 2018,including parapneumonic effusions,tuberculous pleural effusion,cases of malignant pleural effusion and transudative pleural effusion.2.Routine analysis,lactate dehydrogenase,adenosine deaminase and C-reactive protein examination of all pleural effusions were performed,as well as serum C-reactive protein.The levels of heparin-binding protein in the patients' pleural fluid were measured byELISA.3.Receiver operating characteristic curve was plotted to evaluate the diagnostic value of heparin-binding protein,lactate dehydrogenase,adenosine deaminase,C-reactive protein and serum C-reactive protein for parapneumonic effusion.Receiver operating characteristic curve was plotted to evaluate the diagnostic value of heparin-binding protein for parapneumonic effusion and tuberculous pleural effusion.A scatter plot was performed to analyze the correlation between pleural effusion HBP and pleural effusion polymorphonuclear cell countResults1.The concentration of heparin-binding protein was low in malignant pleural effusion[15.2(8.4,33.3)ng/ml]and transudative effusion[14.1(6.5,23.0)ng/ml],but high in parapneumonic effusion[316.1(99.5,399.8)ng/ml]and tuberculous pleural effusion[64.7(18.6,96.8)ng/ml].The heparin-binding protein level in parapneumonic effusion was significantly different from the other three groups(H=120.3,P<0.05).The receiver operating characteristic curve analysis for an optimal discrimination between parapneumonic effusion from non-parapneumonic effusion could be performed at a cut-off point of 64.2ng/ml with area under the curve of 0.953[sensitivity:88.9%(64/72),specificity:89.7%(105/117),positive predictive value:84.2%(64/76),negative predictive value:92.9%(105/113)].2.The concentration of lactate dehydrogenase in parapneumonic effusion[373.0(224.9,741.8)U/L],tuberculous pleural effusion[214.9(165.0,305.2)U/L],malignant pleural effusion[230.4(154.1,418.4)U/L]and transudative effusion[93.4(75.4,141.9)U/L].The level in parapneumonic effusion was significantly different from the other three groups(H=65.5,P<0.05)The concentration of adenosine deaminase in parapneumonic effusion[16.7(8.2,52.1)U/L],tuberculous pleural effusion[38.7(26.5,54.5)U/L],malignant pleural effusion[12.1(7.4,15.5)U/L]and transudative effusion[4.7(3.5,7.5)U/L].The level in parapneumonic effusion was significantly different from the other three groups(H=66.7,P<0.05).The concentration of C-reactive protein in parapneumonic effusion[19.9(11.4,82.1)mg/l],tuberculous pleural effusion[15.6(6.5,23.8)mg/l],malignant pleural effusion[13.1(5.7,19.6)mg/l]and transudative effusion[3.1(1.5,7.7)mg/l].The level in parapneumonic effusion was significantly different from the other three groups(H=17.0,P<0.05).The concentration of serum C-reactive protein in parapneumonic effusion[50.4(23.8,123.5)mg/l],tuberculous pleural effusion[27.2(11.4,56.8)mg/l],malignant pleural effusion[31.8(15.5,60.8)mg/l]and transudative effusion[23.0(6.0,47.3)mg/l].The level in parapneumonic effusion was significantly different from the other three groups(H=14.0,P<0.05).3.The concentration of heparin-binding protein in parapneumonic effusion[316.1(99.5,399.8)ng/ml]and tuberculous pleural effusion[64.7(18.6,96.8)ng/ml],The heparin-binding protein level in parapneumonic effusion was significantly different from tuberculous pleural effusion(Z=-5.424,P<0.05).The receiver operating characteristic curve analysis for an optimal discrimination between parapneumonic effusion from tuberculous pleural effusion could be performed at a cut-off point of 98.1 ng/ml with area under the curve of 0.885[sensitivity:79.2%(57/72),specificity:83.3%(20/24),positive predictive value:93.4%(57/61),negative predictive value:57.1%(20/35)].4.The pleural effusion HBP concentration level was used as the ordinate,and the pleural effusion polymorphonuclear cell count(calculated as 1000×106/l when the pleural effusion polymorphonuclear cell count(?)1000×106/l)was plotted as the abscissa figure.Correlation between HBP concentration in pleural effusion and polymorphonuclear cell count in pleural effusion was R2=0.352(P=0.000).Conclusions1.Pleural effusion HBP level can better distinguish the parapneumonic effusion in patients with pleural effusion.2.The efficacy of pleural effusion HBP in the differential diagnosis of parapneumonic pleural effusion is higher than that of pleural effusion LDH,pleural effusion ADA,pleural effusion CRP and serum CRP.Heparin-binding protein in pleural effusion has high differential diagnosis and can better distinguish parapneumonic effusion from other types of pleural effusion.The detection of heparin-binding protein in pleural effusions has good sensitivity and specificity.It may be a biomarker for differential diagnosis of parapneumonic effusion.3.Pleural effusion HBP level in the differential diagnosis of parapneumonic pleural effusion and tuberculous pleural effusion has a good positive predictive value.4.The correlation between HBP concentration in pleural effusion and polymorphonuclear cell count in pleural effusion is not high.