The Diagnostic Value Of The Combined Detection Of Multiple Indicators In Tuberculous Pleurisy

Background and Purpose Tuberculous pleurisy is a common and severe extrapulmonary tuberculosis.Although there are many diagnostic tools,the proportion of etiological diagnosis is low.The diagnosis of most tuberculous pleurisy is still based on clinical comprehensive judgment.This study aimed to evaluate the diagnostic value of T-SPOT.TB and routine biomarkers in tuberculous pleurisy.Materials and Methods A total 375 patients with pleural effusion were collected from The First Affiliated Hospital,College of Medicine,Zhejiang University from February 2018 to April 2019.Of those,188 patients had tuberculous pleural effusion,187 patients had non-tuberculous pleural effusion.For all patients with peripheral blood T-SPOT.TB testing,pleural effusion ADA activity determination and other routine laboratory testing;and 166 of them with pleural effusion T-SPOT.TB testing.To evaluate the diagnostic value of the combined detection of multiple indicators in tuberculous pleurisy.Results(1)The sensitivity and specificity of peripheral blood T-SPOT.TB testing were 81.9%and 79.7%.The ROC curve determined the cut-off value of pleural effusion ADA activity was 21.5U/L,and the sensitivity and specificity were 76.1% and 89.7%.The sensitivity and specificity of pleural effusion T-SPOT.TB testing were 81.9% and79.7%.(2)In a combination of detection:a series of peripheral blood T-SPOT.TB testing,pleural effusion ADA activity determination and pleural effusion T-SPOT.TB testing highest specificity was 98.5%,but sensitivity was only 58.4%.The sensitivity of a parallel joint detection of three detection methods was the highest(98%),which was equal with the sensitivity of pleural effusion T-SPOT.TB testing or peripheral blood T-SPOT.TB,pleural effusion T-SPOT.TB testing or pleural effusion ADA activity determination.And the specificity of them were less than 60%.As for overall diagnostic performance,the accuracy of peripheral blood T-SPOT.TB combined with pleural effusion ADA activity was the highest(82.4%).(3)The correlation coefficient between pleural effusion ADA activity and age was-0.234(P<0.001).ADA activity determination in younger tuberculous pleurisy patients was significantly higher than which of elder tuberculous pleurisy patients(P<0.05).The differences were no statistically significant between middle-aged group and the older group(P>0.05).Conclusions(1)The sensitivity of pleural effusion T-SPOT.TB testing was high while the specificity was low.The cut-off value remains to be explored.(2)Compared with each method itself,combination test can significantly improve the sensitivity and specificity,reducing missed diagnosis and misdiagnosis,of which the peripheral blood T-SPOT.TB combined with pleural effusion ADA activity was best.(3)Age affects pleural effusion ADA activity in patients with tuberculous pleurisy.Clinicians should take full account of ADA activity in the diagnosis of tuberculous pleurisy.