| Objective:The differential diagnosis of tuberculous pleurisy and non tuberculous pleurisy is very important for clinical treatment.The existing tuberculosis diagnosis method has low positive rate for pleural effusion,and the price is high,so it is difficult for basic hospitals to carry it out in a large scale.Our research evaluated the combination of some indicators in the diagnosis of tuberculous pleurisy by studying the diagnostic efficiency of the indicators,namely ADA,its isoenzyme ADA2,ADA2/ADA,and lymphocyte(L)/ neutrophil(N)ratio.Methods:(1)32 patients with tuberculous pleurisy came from in certain grade-three general hospital of Changsha and diagnosed clinically were analyzed during January 2019 and December 2019.At the same time,123 patients with non-tuberculous pleurisy were collected as control.All the samples were collected for ADA detection.(2)32 samples of tuberculosis pleurisy were performed for Mycobacterium tuberculosis rapid culture,QFT and Gene Xpert MTB/RIF,respectively.According to the results of the three methods,the tuberculous pleurisy was divided into positive group and negative group.ADA expression levels in each group were compared,and the diagnostic value of three methods for tuberculouspleurisy was analyzed.(3)The activity of ADA and ADA2 were detected by peroxidase method,the ratio of lymphocyte(L)to neutrophil(N)was counted by cell count method,and the ROC curves were calculated respectively.The diagnostic value of ADA and ADA2 and L/N ratio in tuberculous pleurisy was analyzed.Results:1.In tuberculous pleurisy,the expression level of ADA of tuberculosis culture positive group was(62.5 ± 20.4)U/ L,and that of the tuberculosis culture negative group was(65.1 ± 22.4)U/L,there was no significant difference in ADA between the two groups(P > 0.05);the expression level of ADA of QFT positive group was(64.7 ± 20.5)U/ L,which was not significantly different from that of QFT negative group(62.9 ± 23.3)U/ L(P > 0.05);the expression level of ADA of Gene Xpert MTB / RIF positive group was(62.9 ± 20.9)U/ L,which was not significantly different from that of Gene Xpert MTB / RIF negative group(64.7 ± 23.3)U/L(P > 0.05);in addition,the expression of ADA were significantly higher in tuberculous pleurisy group(63.8±21.4)U/L than in non-tuberculous group(33.7 ± 88.4)U /L(P < 0.05).2.The detection rates of tuberculosis culture,QFT and Gene Xpert MTB /RIF were 34.3%,65.6% and 34.3%,respectively.The positive rate of QFT was significantly higher than that of TB culture(P<0.05)and Gene Xpert MTB/RIF(P<0.05).The difference was statisticallysignificant.the results of Gene Xpert MTB/RIF test was consistent with tuberculosis culture,and there was no significant difference between the two detection methods(P > 0.05).3.The sensitivity and specificity of diagnosing tuberculous pleurisy were 90.6% and 88.6% respectively when the ADA threshold was 48 U/L;The sensitivity and specificity were 90.6% and 94.3% respectively when the ADA threshold was 26 U/L.The sensitivity and specificity were100% and 48.8% respectively when the L/N threshold was 0.70;when 48U/L of the ADA threshold combined with 0.7 of L/N threshold,The sensitivity and specificity of diagnosing tuberculous pleurisy were 90.6%and 98.4% respectively;when 26 U/L of the ADA2 threshold combined with 0.7 of L/N threshold,the sensitivity and specificity of diagnosing tuberculous pleurisy were 90.6% and 97.6% respectively;when the combination of 48 U/L of the ADA threshold,26 U/L of the ADA2 threshold and 0.7 of L/N threshold,the sensitivity and specificity of diagnosing tuberculous pleurisy were 96.9% and 97.6% respectively.Conclusions:QFT is more sensitive than mycobacterium culture and Gene Xpert MTB / RIF in the diagnosis of tuberculous pleurisy;ADA combined with ADA2 and the lymphocytes/neutrophils ratio may increase a clinical diagnostic value for tuberculous pleurisy. |
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