| ObjectsTo measure the Mycobacterium Tuberculosis-Deoxyribonucleic acid(TB-DNA)by Real-time Quantitative polymerase chain reaction(RQ-PCR)technology,observe its clinical value in the diagnosis of tuberculosis,and focus on the clinical diagnosis value of tuberculous pleurisy.MethodsA total of 122 patients with treated in the Department of Respiratory and Critical Care Medicine in the First Affiliated Hospital of Xi'an Medical University and Shaanxi Provincial Tuberculosis Prevention and Treatment Hospital from January 2019 to January 2020 were collected and divided into two groups,including 61 cases of tuberculosis and 61 cases of non-tuberculosis group,of which the tuberculosis group included 25 cases of tuberculous pleural effusion group and the non-tuberculosis group included 31 cases of non-tuberculous pleural effusion group.All enrolled patients were collected clinical information,and pleural puncture or closed drainage of thoracic cavity was collected within 48 hours of admission to collect pleural effusion samples,or deep sputum samples,or obtain bronchoalveolar lavage fluid samples by electronic bronchoscopy,using RQ-PCR technology was used to detect TB-DNA in the specimens.For Patients with pleural effusion,routine pleural effusion,biochemical,ADA,and peripheral blood T-SPOT tests were performed.Relevant statistical analysis included Shapiro-Wilk(W test),T test,Man Whitney U test,and c2 test.There were statistical differences at P<0.05,and significant statistical differences at P<0.01.The positive and negative rates of TB-DNA in the patients were counted separately.The sensitivity,specificity,positive predictive value,and negative predictive value of pleural effusion TBDNA,pleural effusion ADA,and peripheral blood T-SPOT were measured separately,serial joint detection and parallel joint detection are calculated,respectively.Pleural effusion TBDNA,pleural effusion ADA and peripheral blood T-SPOT test results were all positive as a positive result in serial joint detection,any one of pleural effusion TB-DNA,pleural effusion ADA and peripheral blood T-SPOT results was positive as a positive result in parallel joint detection.Results1.The positive rates of TB-DNA in pulmonary tuberculosis group and non-tuberculosis group were 65.57% and 0.00%,respectively.The positive rate of TB-DNA in tuberculosis group was significantly higher than that in non-tuberculous group,there was a statistically significant difference between the two groups(P<0.01).The positive rates of TB-DNA in the effusion group and non-tuberculous pleural effusion group were 24.00% and 0.00%,respectively.The positive rate of TB-DNA in the tuberculous pleural effusion group was significantly higher than that in the non-tuberculous pleural effusion group,there was a statistically significant difference between the two groups(P<0.01).2.The positive rates of ADA in tuberculous pleural effusion group and non-tuberculous pleural effusion group were 56.00% and 3.23%,respectively.The positive rate of ADA in tuberculous pleural effusion group was significantly higher than that in non-tuberculous pleural effusion group,there was a statistically significant difference between the two groups(P<0.01).The median and interquartile range of ADA content in tuberculous pleural effusion group was 50.00(31.75-64.00)U/L,and the median and interquartile range of ADA content in non-tuberculous pleural effusion group was 6.30(4.10-13.00)U/L,there was a statistically significant difference between the two groups(Z =-5.447,P=0.000<0.01).3.The positive rates of T-SPOT in tuberculous pleural effusion group and nontuberculous pleural effusion group were 96.00% and 25.81%,respectively.The positive rate of T-SPOT in tuberculous pleural effusion group was significantly higher than that in nontuberculous pleural effusion group,there was a statistically significant difference between the two groups(P<0.01).4.Single pleural effusion TB-DNA,pleural effusion ADA,peripheral blood T-SPOT single test results: the sensitivity,specificity,positive predictive value,and negative predictive value of TB-DNA were 24.00%,100.00%,100.00% and 62.00%.The sensitivity,specificity,positive predictive value,and negative predictive value of ADA were 56.00%,96.77%,93.33%,and 73.17%.The sensitivity,specificity,positive predictive value and negative predictive value of T-SPOT were 96.00%,74.19%,75.00% and 95.83%.5.Peripheral blood T-SPOT detection sensitivity was higher than that of pleural effusion ADA,there was a statistical difference between the two groups(c2 = 6.750,P<0.05).Pleural effusion detection sensitivity was higher than pleural effusion TB-DNA,there was a statistical difference between the two groups(c2 = 4.083,P<0.05).The specificity of pleural effusion TB-DNA detection was higher than that of peripheral blood T-SPOT,there was a statistical difference between the two groups(c2 = 6.125,P<0.05).The specificity of pleural effusion ADA detection was higher than peripheral blood T-SPOT,there was a statistical difference between the two groups(c2 = 4.000,P<0.05).There was no statistical difference between the specificity of pleural effusion TB-DNA test and pleural effusion ADA test(c2 = 0,P>0.05).When pleural effusion TB-DNA,pleural effusion ADA,and peripheral blood T-SPOT are combined in series,the specificity,positive predictive value and negative predictive value are as high as 100.00%,100.00% and 100.00%,respectively.The sensitivity is 16.00%;the sensitivity and negative predictive values were as high as 100.00% and 100.00%,and the specificity was 70.97%,and the negative predictive value was 73.53%.6.When pleural effusion TB-DNA,pleural effusion ADA and peripheral blood T-SPOT were combined in series,the specificity,positive predictive value and negative predictive value were as high as 100.00%,100.00% and 100.00%,respectively.The sensitivity was 16.00%.The sensitivity and negative predictive value were as high as 100.00% and 100.00% and the specificity was 70.97% and the negative predictive value was 73.53%.7.The pleural effusion white blood cell count,pleural effusion total protein,ADA,LDH content in the tuberculous pleural effusion group was significantly higher than that in the nontuberculous pleural effusion group,there was a significant statistical difference between the two groups(P<0.01).The tuberculous pleural effusion group chest The percentage of neutrophils,lymphocytes in water and non-tuberculous pleural effusion group were not statistically different(P>0.05).The pleural effusion CEA content of tuberculous pleural effusion group was significantly lower than that of non-tuberculous pleural effusion group,there was a significant statistical difference between the two groups(P<0.01).8.The peripheral blood erythrocyte sedimentation rate and total liver function protein content in the tuberculous pleural effusion group were higher than those in the nontuberculous pleural effusion group,there was a statistically significant difference between the two groups(P<0.05).The peripheral blood FIB content in the tuberculous pleural effusion group was significantly higher in the non-tuberculous pleural effusion group,there was a statistically significant difference between the two groups(P<0.01).The peripheral blood CRP,PCT,D-dimer in the tuberculous pleural effusion group compared with the non-tuberculous pleural effusion group There was no statistical difference(P>0.05).Conclusions1.Pleural effusion TB-DNA was combined with pleural effusion ADA or peripheral blood T-SPOT to perform two types of diagnostic methods in series(pleural effusion TBDNA + pleural effusion ADA,pleural effusion TB-DNA + peripheral blood T-SPOT)or three types of diagnostic methods in series(TB-DNA + pleural effusion + ADA + peripheral blood T-SPOT)has high specificity,which can better reduce the clinical misdiagnosis rate.2.Pleural effusion TB-DNA was combined with pleural effusion ADA or peripheral blood T-SPOT to perform two types of diagnostic methods in parallel(pleural effusion TBDNA + pleural effusion ADA,pleural effusion TB-DNA + peripheral blood T-SPOT)or three types of diagnostic methods in parallel(pleural effusion TB-DNA + pleural effusion ADA + peripheral blood T-SPOT)has a higher sensitivity,which can better reduce the clinical missed diagnosis rate.3.RQ-PCR detection of pleural effusion TB-DNA has high specificity for the diagnosis of tuberculous pleurisy,but it has low sensitivity and relatively high cost.It is recommended to use it in combination with other indicators in clinical work. |
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