M. Tuberculosis Protein Chip Joint Pleural Effusion PCR, Anti-TB-SA Study The Diagnostic Value Of Tuberculous Pleurisy

Research objective:To investigate the clinical diagnostic value of protein chip technology that it detected tuberculosis antibody in tuberculous pleurisy patients serum and fluorescence quantitative PCR that it tested mycobacterium tuberculosis DNA in pleurisy effusion and ELISA method that it tested tuberculosis bacterium secreted acid phosphatase antibody in pleurisy effusion alone, and to investigate the clinical diagnostic value of combine detection.Research methods:The suspected tuberculous pleurisy patients with pleural effusion who came from January2010to October2013in taiyuan fourth people’s hospital first treated as the research object.they were detected by protein chip technology that it detected tuberculosis antibody in tuberculous pleurisy patients serum and fluorescence quantitative PCR that it tested mycobacterium tuberculosis DNA in pleurisy effusion and ELISA method that it tested tuberculosis bacterium secreted acid phosphatase antibody in pleurisy effusion. At same time pleurisy fluid was tested by routine biochemical、pleural fluid smear,、mycobacterial culture of pleural fluid、pleural fluid cytology. To select50cases of pleural fluid culture positive for M. tuberculosis,36cases of cancerous pleurisy,57cases of men and29cases of women, pleurisy patients are divided into tuberculous pleurisy and cancerous pleurisy. A retrospective case-control study method, analysis and calculation tuberculosis protein chip, TB-PCR and antiTB-SA separate and joint detection of specific degrees, sensitivity, and positive rate.Research result:①Result show:The sensitivity of tuberculosis protein chip was28%, the specificity was94.4%, the positive likelihood ratio was5.04, the positive predictive value was0.875, the youden’s index was0.224, the agreement rate was0.558, the area under the ROC curve was0.612. The sensitivity of antiTB-SA was76%, the specificity was44.4%, the positive likelihood ratio was1.368, the positive predictive value was0.655, the youden’s index was0.204, the agreement rate was0.628, the area under the ROC curve was0.602. The sensitivity of TB-PCR was72%, the specificity was63.9%, the positive likelihood ratio was3.86, the positive predictive value rate was0.735, the youden’s index was0.359, the agreement rate was0.686, the area under the ROC curve was0.679in the three selected method.②Tuberculosis protein chip, antiTB-SA and TB-PCR area under the curve compared with no value curve was statistically significant (P<0.05); Comparison of the three methods each other was no statistical significance (P>0.05).the specificity of tuberculosis protein chip was highest(94.40%), but the sensitivity was lowest(28.00%). The sensitivity of antiTB-SA and TB-PCR was higher than tuberculosis protein chip(76.00%,72.00%),but the specificity was significantly lower than the specificity of protein chip technology(44.40%,63.90%). There was significant difference in sensitivity and specificity between tuberculosis protein chip and antiTB-SA and TB-PCR.There was no significant differences in sensitivity and specificity between TB-PCR and antiTB-SA.③Result show:The sensitivity of TB-PCR+antiTB-SA was94%,the specificity was25%, the positive likelihood ratio was1.253, the positive predictive value was0.635, the youden’s index was0.17, the agreement rate was0.651, the area under the ROC curve was0.595. The sensitivity of TB-PCR+tuberculosis protein chip was76%, the specificity was58.3%, the positive likelihood ratio was1.824, the positive predictive value was0.717, the youden’s index was0.343, the agreement rate was0.686, the area under the ROC curve was0.672. The sensitivity of tuberculosis protein chip+antiTB-SA was76%, the specificity was44.4%, the positive likelihood Ratio was1.368, the positive predictive value was0.655, the youden’s index was0.204, the agreement rate was0.628, the area under the ROC curve wasO.602. The sensitivity of antiTB-SA+TB-PCR+tuberculosis protein chip was94%, the specificity was25%, the positive likelihood ratio was1.253, the positive predictive value was0.635, the youden’s index was0.17, the agreement rate was0.651,the area under the ROC curve was0.595in the two joint two or three joint method.④Three methods of two joint two or three joint detection area under the curve which compared with no value curve was statistically significant (P<0.05);Comparison of the two joint two or three methods each other was no statistical significance (P>0.05).the sensitivity of TB-PCR+antiTB-SA and antiTB-SA+TB-PCR+tuberculosis protein chip was significant high(94%), there was significant difference between sensitivity and other combinations (P<0.05); but the specificity decreased obviously (25%).,there was significant difference with the specificity TB-PCR+tuberculosis protein chip (P<0.05), and the specificity antiTB-SA+tuberculosis protein chip had no significant difference(P>0.05). The sensitivity of TB-PCR+tuberculosis protein chip and anti tuberculosis protein chip combined+antiTB-SA was the same as76%, but the specificity (58.30%,44.40%) showed significant difference (P<0.05).Conclusions:(1) The specific of tuberculosis protein chip was high, but low sensitivity, the positive diagnosis of tuberculosis pleurisy rate was low.(2) The sensitivity of antiTB-SA and TB-PCR technology was higher than the results of tuberculosis protein chip, but the specificity reduction. Selection of anti TB-SA and TB-PCR combined detection as screening index, the screening positive were examined by single tuberculosis protein chip for diagnosis.