| Objective: To study the diagnosis value and related influencing factors in tuberculous pleural effusion by tuberculosis protein chip,interferon-gamma release assays(IGRA),medical thoracoscopy in order to provide for early diagnosis and treatment of tuberculous pleural effusion.Methods: A retrospective analysis of the affiliated hospital of southwest medical university of 407 in-hospital patients in July 1,2013 to December 31,2015,of which by medical thoracoscopy 230 cases of tuberculous pleural effusion and 121 cases of malignant pleural effusion,13 cases of other pleural effusion,43 cases have not been diagnosed.We count the clinical data,laboratory examination(tuberculosis protein chip,IGRA)and pleural morphological manifestation,the pathological results of biopsy of pleurall under medical thoracoscopy,treatment and prognosis,establish database and analyzed the data.Results: 1.230 cases of tuberculous pleural effusion,accounting for 56.51%(230/407),15 years old to 83 years old,the median is 43 years old,the ration of male:female was 3:1 in these cases,non-elderly group fever,chest pain significantly more than the older group,the differences were statistically significant(P<0.05).2.IGRA were sensitive and specific about 74.29% and 76.32%,positive predictive value was 89.66%,tuberculosis protein chip was 83.05% for specific and 81.48% for positive predictive value,the sensitive and negative predictive value of IGRA more than tuberculosis protein chip’s data,the difference were statistically significant(P<0.05).3.The sensitivity of the IGRA of blood and tuberculosis protein chip by the parllel detection can be enhanced up to 82.89%,and series detection of the above can be increased the specific up to 88.24%.4.The positive of LAM and 38 KD and16KD in the tuberculosis protein chip were about 24.12% and 24.71% and 4.12%,but the specific of 16 KD reach 100%,the positive of analysis of LAM,38 KD and 16 KD up to 25.88%,it slightly higher than the individual.5.The sensitivity of IGRA in non-elderly group was 80.26% higher than the older group of 58.62%,the specific of older group was 91.3% higher than non-elderly group of 53.33%,the difference were statistically significant(P<0.05);the secretion of IFN-γ in non-elderly group higher than non-elderly group,the difference was statistically significant(P<0.05);the specific,sensitivity,positive predictive value of tubeculosis protein chip between older group and non-elderly group,there were no statistical significance.6.Medical thoracoscopy pleural biopsy tuberculosis PCR of positive compared with the negative of IGRA’s positive rate,the secretion of IFN-γ,there were no statistical significance.7.407 cases undergo medical thoracoscopy,the positive was 74.20%(302/407),the positive of combination of medical thorascopy and clinical manifestation reached 86.73%(353/407).8.230 cases of tuberculous pleural effusion with medical thoracoscopy(mainly lensions):(1)acute exudative inflammation stage(19 cases,8.3%).(2)hyperplasis(125 cases,54.3%).(3)fiber adhension stage(70 cases,30.4%).(4)pleural hypertrophy stage(16 cases,7%).9.The manifestation of tuberculosis and malignant pleural effusion include congestion edema,scattered small nodules,military nodules,the degree of adhension,bump,tiles shaped in pleural were compared in two groups,there were statistically significant difference(P<0.05),the thicking of pleural was no significant difference.Conclusion: 1.Tuberculous pleural effusion is the most common cause of exudative pleural effusion in the affiliated hospital of southwest medical university,usually seen in young man,especially the patient with fever,pleural effusion with chest pain to be considered tuberculous pleural effusion.2.IGRA is of good value for tuberculous pleural effusion,mainly infiuenced by age factor,not but the amount load of bacteria.3.The low sensitivity but high specific of tuberculosis protein chip,which maybe suitable for all ages detection,especially the specific of 16 KD reached 100%.4.The combination of tuberculosis protein chip and IGRA can improve the analysis capability.5.The medical thoracscopy as a means of minimally invasive,it’s of high value for the disease of pleural.6.The patients of tuberculosis and malignant pleural effusion included lots of manifestation,but each with distinct characteristics,the tuberculosis pleural effusion is mainly congestion edema,scattered small nodules,military nodules,adhension,the specific manifestation was mixture;the malignant pleural effusion usually seen bump,tiles shaped.According to the morphology of pleural,it’s helpful to identify the cause of pleural effusion. |
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