Clinical Significance Of Xpert MTB/RIF And T-SPOT.TB In Diagnosis Of Tuberculous Pleurisy

Objective:The diagnostic value of Xpert MTB/RIF and T-SPOT.TB in tuberculous pleurisy were investigated,and the value of combined detection of Xpert MTB/RIF and T-SPOT.TB was further explored.Methods:Patients with pleurisy hospitalized for the first time in Hebei chest hospital from June2017 to November 2020 were retrospectively collected.They were divided into tuberculous pleurisy group and non tuberculous pleurisy group according to the diagnostic criteria.The level of ADA and the number of spot forming cells detected by T-SPOT.TB in pleural effusion were compared between the two groups.The ROC curves of the two methods were drawn to determine the accuracy in the diagnosis of tuberculous pleurisy.The sensitivity and specificity,positive predictive value and negative predictive value of Xpert MTB/RIF,T-SPOT.TB and other methods in diagnosing tuberculous pleurisy were calculated.Compare the efficacy of different methods in the diagnosis of tuberculous pleurisy.The diagnostic value of Xpert MTB/RIF and T-SPOT.TB in tuberculous pleurisy was evaluated.Results:(1)The results of Xpert MTB/RIF and rapid culture of Mycobacterium tuberculosis in pleural effusion: Among 132 cases of tuberculous pleurisy,28 cases were positive for Xpert MTB/RIF,23 cases were positive for rapid culture of Mycobacterium tuberculosis,and 85 cases of non tuberculous pleurisy were negative for Xpert MTB/RIF and rapid culture of Mycobacterium tuberculosis.The sensitivity of Xpert MTB/RIF assay was 21.2%,and the sensitivity of rapid culture was 17.4%.The specificity of both methods was 100%.(2)The results of T-SPOT.TB and adenosine deaminase in pleural effusion: The number of spot forming cells and level of ADA in patients with tuberculous pleurisy were significantly higher than those in patients with non tuberculous pleurisy(P<0.05).The area under the curve of T-SPOT.TB was 0.895,which was higher than that under the curve of ADA(0.858).The sensitivity and specificity of T-SPOT.TB for diagnosing tuberculous pleurisy were 78.8% and 95.3%,and the sensitivity and specificity of ADA for diagnosing tuberculous pleurisy were 62.9% and 92.9%.(3)The diagnostic efficiency of different methods was compared: The sensitivity of Xpert MTB/RIF in pleural effusion was 21.2%,which was significantly lower than that of T-SPOT.TB and ADA(P<0.05).But it was similar to that of Mycobacterium tuberculosis rapid culture(P>0.05).And in the study,there was no significant difference in specificity among Xpert MTB/RIF,T-SPOT.TB,ADA and Mycobacterium tuberculosis culture(P>0.05).Compared with ADA,the accuracy and sensitivity of T-SPOT.TB in the diagnosis of tuberculous pleurisy were higher(P<0.05).The sensitivity of combined detection of tuberculous pleurisy was 84.8%,which was significantly higher than that of Xpert MTB/RIF(P<0.05),and similar to that of T-SPOT.TB(P>0.05).The specificity of combined detection was 95.3%,which was similar to that of T-SPOT.TB and Xpert MTB/RIF(P>0.05).Compared with clinical diagnosis,the combination of T-SPOT.TB and Xpert MTB/RIF has the best consistency in the diagnosis of tuberculous pleurisy(kappa=0.775,P<0.05).The ROC curve of each detection method was drawn,and the area under the ROC curve of the combination of Xpert MTB/RIF and T-SPOT.TB was 0.920.Conclusion:(1)The sensitivity of Xpert MTB/RIF in the diagnosis of tuberculous pleurisy needs to be further improved,but its high specificity has high value in the determination of tuberculosis,and the detection speed is significantly better than that of rapid culture in pleural effusion.(2)The sensitivity and specificity of T-SPOT.TB in the diagnosis of tuberculous pleurisy were high,and the sensitivity was significantly higher than that of ADA.And it can provide a strong basis for the clinical diagnosis of tuberculous pleurisy.(3)The combination of Xpert MTB/RIF and T-SPOT.TB has the best consistency compared with clinical diagnosis,and it has the highest diagnostic value compared with other methods.And it is more reliable for rapid diagnosis of tuberculous pleurisy.