Diagnostic Value Of Multiple Laboratory Indicators In Tuberculous Pleurisy

Objective:To explore the clinical significance of multiple laboratory indicators,including pleural effusion lactate dehydrogenase(LDH),pleural effusion adenosine deaminase(ADA),pleural effusion mononuclear cell ratio(PEMC),erythrocyte sedimentation rate(ESR),tuberculosis antibody(TB-Ab)and T cell spot test(T-SPOT)in the diagnosis of tuberculous pleurisy.Furthermore,to detect the combined diagnostic value of several indicators in tuberculous pleurisy so as to improve the diagnostic efficiency in clinical work.Methods:Patients with unilateral pleural effusion that were diagnosed definitely from January 2014 to September 2019 in Department of Respiratory Medicine,Shandong Provincial Hospital were enrolled and divided into two groups:tuberculous pleurisy(TP)group and nontuberculous pleurisy(NTP)group.Patients in TP group were all diagnosed on the basis of bacteriological evidence or pathology results while patients in NTP group were all diagnosed malignant pleural effusion according to pleural effusion cytology or medical thoracoscopy pathology results.Compare the difference in pleural effusion LDH,pleural effusion ADA,PEMC,ESR,TB-Ab,T-SPOT between the two groups and evaluate the diagnostic value of each significant indicator for tuberculous pleurisy.Then analyze the combined value of several indicators in tuberculous pleurisy diagnosis by receiver operator characteristic curve(ROC)curve.Results:A total of 120 patients were included in this study,all of whom were clearly diagnosed by pathology,etiology or cytology,including 59 patients with tuberculous pleural effusion and 61 patients with nontuberculous pleural effusion.1.There were significant differences in age and gender composition between the two groups.The mean age of patients in the TP group was 43.69±17.870 years,while that in the NTP group was 59.64±12.976 years(t=-5.577,P ＜0.001).Male patients accounted for 76.27%(45/59)in the TP group and 57.38%(35/61)in the other group(χ2=4.818,P=0.028).There was no significant difference between the two groups in disease location or admission season.2.There were differences in pleural effusion ADA,PEMC and ESR between the two groups,but no statistical differences in pleural effusion LDH.The median and interquartile rang[M(IQR)]of ADA was 39.80(24.00)U/L in TP group and 10.00(6.60)U/L in NTP group.ADA in TP group was significantly higher than that in NTP group with statistical significance(P ＜0.001).The M(IQR)of PEMC in the two groups were 97%(11%)and 81%(23%),respectively,and the difference was statistically significant(P ＜0.001).The difference in ESR between the two groups was also statistically significant(39.32±24.141mm/h VS 25.80±18.163mm/h,P=0.001).As for pleural LDH,there was no statistical difference[386.30(262.10)U/L VS 404.10(437.88)U/L,P=0.505].3.When single indicator was used to diagnose tuberculous pleurisy,the optimal cutoff value,sensitivity and specificity were:pleural effusion ADA(＞ 20.85u/L)89.8%and 91.8%,PEMC(＞ 94.5%)62.7%and 88.5%,ESR(＞ 36.5mm/h)55.9%and 83.6%,respectively.When the above indicators were detected separately,the diagnostic value of pleural effusion ADA for tuberculous pleurisy was the highest(AUC=0.970),followed by PEMC(AUC=0.776),and the diagnostic value of ESR was the lowest(AUC=0.680).4.The sensitivity and specificity of TB-Ab in diagnosis of tuberculous pleurisy were respectively 15.3%and 96.7%.The sensitivity and specificity of T-SPOT were 88.1%and 78.7%,respectively.5.The sensitivity and specificity of ADA combined with PEMC were respectively 93.2%,95.1%,and AUC=0.988.The sensitivity and specificity of ADA combined with ESR were 89.8%and 91.8%,AUC=0.970,and that of PEMC combined with ESR were 62.7%and 80.3%,AUC=0.761.To sum up,pleural effusion ADA combined with PEMC had the highest diagnostic value,which was better than ADA alone.Conclusion:The sensitivity of TB-Ab is low while the specificity is high;the sensitivity and specificity of T-SPOT are relatively high.The above two indicators have certain value in the diagnosis of tuberculous pleurisy.Pleural effusion ADA has a high diagnostic value for tuberculous pleurisy,and the optimal cutoff value is 20.85U/L.Compared with ADA alone,the combined detection of pleural effusion ADA and PEMC can further improve the sensitivity and specificity of diagnosis,which can be used as an effective strategy for the diagnosis of tuberculous pleurisy,deserving clinical application.