| Objective:To understand the etiological composition of patients with pleural effusion and the differences in clinical characteristics of PE caused by different etiologies,and to explore its diagnostic value in PE by analyzing pleural effusion LDH/ADA,so as to provide reference for the etiological diagnosis of pleural effusion,thereby further improving the level of diagnosis and treatment of pleural effusion.Methods:The cases and general data of inpatients with PE in the Department of Respiratory and Critical Care Medicine,Yulin First Hospital from January 2016 to January2021 were retrospectively analyzed.According to the different etiologies of PE,patients were divided into malignant group and benign group,and the benign group was further divided into bacterial infection group,tuberculosis group,heart failure group and other cause groups.All patients were divided into groups A,B,and C according to their age.Group A was≤45 years old,group B was 46～60 years old,and group C was>60 years old.The patients’gender,age,smoking status,clinical symptoms,fever,hemoptysis,shortness of breath,cough,chest pain,expectoration,etc.,pleural effusion location（left,right,bilateral）,chest CT imaging findings,Detection of pleural effusion biochemical and routine examinations,peripheral blood neutrophil count,lymphocyte count,monocyte count and platelet count,fibrinogen（FIB）,D-2 polymer（DD）,lactate dehydrogenase（LDH）,adenosine deaminase（ADA）,NLR（blood neutrophil count/lymphocyte count）,PLR（blood platelet count/lymphocyte count）,pleural effusion LDH/ADA（lactate dehydrogenase/adenosine deaminase）.Multivariate Logistic regression was further established,with benign and malignant pleural effusion as dependent variables,the OR value was calculated to analyze the risk factors of PE etiology due to malignant tumors,and the ROC curve was drawn to analyze the diagnostic value of LDH/ADA in the etiology of PE.Results:1.The Department of Respiratory and Critical Care Medicine of Yulin First Hospital has treated 304 PE patients in the past 5 years.The etiology included 128 cases（42.1%）of tuberculosis,83 cases（27.3%）of malignant tumors,and 50 cases（16.4%）of pneumonia,of which 4 cases were empyema,40 cases（13.2%）of heart failure,1 case（0.3%）of pulmonary embolism and 2 cases（0.7%）of other etiologies.2.The primary cause of PE in group A（≤45 years old）was tuberculosis（83.5%）;the primary cause of PE in group B（46～60 years old）was malignant tumor（41.9%）;the primary cause of PE in group C（>60 years old）was malignant tumor Tumor（34.7%）.3.The peak age of onset for patients with tuberculosis is 21 to 30 years old,the peak age of onset for patients with malignant tumor is 61 to 70 years old,and the peak age of onset for patients with bacterial infection and heart failure is 71 to 80 years old age.The number of patients with heart failure increases gradually with age.4.Among the 304 PE patients with definite diagnosis,pleural effusion was located on both sides in 96 cases（31.6%）,left side in 91 cases（29.9%）,and right side in 117 cases（38.5%）.There was a statistical difference in the etiological composition of the three groups（P<0.001）;further pairwise comparison found that the etiological composition of the left side and the right side were not statistically significant（P>0.05）;the left side and bilateral pleural effusion had statistical significance,the right side and bilateral pleural effusion were statistically significant（P<0.016）.5.According to the biochemistry and routine of pleural effusion,52（17.1%）of 304PE patients were diagnosed as exudate,and the main cause was heart failure;252（82.9%）were diagnosed as exudate,and the main cause was tuberculosis.Tuberculosis,malignant tumor,bacterial infection,heart failure,and other causes of PE properties were statistically different.6.The detection rate of malignant tumor in bloody pleural effusion is higher than that of non-blood pleural effusion,which is statistically significant（χ~2=16.556,P<0.001）.The detection rate of malignant tumor in exudative bloody pleural effusion is higher than that in exudative non-blood pleural effusion,with statistical significance（χ~2=18.117,P<0.001）.7.The age comparison of the four groups of PE patients with different etiologies was statistically significant（P<0.001）,the heart failure group was the largest,and the tuberculosis group was the smallest.In gender there do not has significant difference comparison between the four groups（P>0.05）.The proportion of smoking among the four groups was statistically significant（P<0.001）.The cancer group had the highest smoking rate,followed by the heart failure group and bacterial infection group,and the smallest in the tuberculosis group.Clinical symptoms such as cough,fever,expectoration,shortness of breath,and chest pain were statistically significant in the four groups（P<0.001）,and the detection rate of fever was significantly higher in the tuberculosis group.8.In terms of PE biochemical indicators:compared between the malignant group and the benign group,the contents of ADA and CRP in the benign group were higher than in the malignant group,and the contents of GLU and LDH/ADA in the benign group It was significantly lower than the malignant group,and the difference has statistical significance（P<0.05）.9.Multivariate Logistic regression analysis showed that smoking history,occurrence of shortness of breath,LDH/ADA were positively correlated with the risk of pleural effusion caused by malignant tumor,and the occurrence of fever symptoms was negatively correlated with pleural effusion caused by malignant tumor.10.Using the ROC curve to evaluate the diagnostic value of LDH/ADA in PE caused by benign and malignant tumors.The results showed that the ratio of LDH/ADA in pleural effusion higher than 21.36 could highly predict the etiology of PE as malignant tumor,and the sensitivity=67.1%;specificity=70.3%（AUC=0.698;P<0.001）.11.Using the ROC curve to evaluate the diagnostic value of LDH/ADA in PE caused by tuberculosis and malignant tumors.When the critical value of LDH/ADA was 19.89,the sensitivity=69.5%;specificity=80.3%.12.Combining LDH/ADA with any one of shortness of breath and smoking history can improve the diagnostic value of PE in malignant tumors.Conclusion:Tuberculosis and malignant tumors are the main causes of PE patients admitted to the Department of Respiratory and Critical Care Medicine of Yulin First Hospital in the past five years.2.The incidence of tuberculosis is mostly in young and middle-aged patients.TPE is still the main cause of PE in young adults in my country.3.Smoking history,the occurrence of shortness of breath,LDH/ADA were positively correlated with the risk of pleural effusion caused by malignant tumor,and the occurrence of fever symptoms was negatively correlated with pleural effusion caused by malignant tumor,which was of great significance for the etiological diagnosis of pleural effusion.4.In the differential diagnosis of MPE and TPE,the combined detection of LDH/ADA in pleural effusion,smoking history and shortness of breath can significantly improve the sensitivity and specificity of diagnosis,reduce the rate of missed diagnosis and misdiagnosis,and has important clinical diagnostic value. |
