Experimental Diagnosis And Prognosis Of Tuberculous Pleural Effusion

Part ? The value of pleural effusion T-SOPT.TB and adenosine deaminase in the diagnosis of tuberculous pleural effusionBackground and Objective Tuberculous pleural effusion(TPE)is the main cause of pleural effusion in the high incidence area of tuberculosis.In clinic,TPE is usually diagnosed by epidemiological,clinical,chest fluid physical and chemical indicators.Adenosine deaminase(ADA)is one of the more accurate and clinically recognized auxiliary indexes for TPE diagnosis.In recent years,T cells spot test of tuberculous infection(T-SPOT.TB)has become a hot method in the diagnosis of tuberculous.Pleural fluid T-SPOT.TB has a high value in the diagnosis of TPE.This study aims to investigate the value of pleural fluid T-SPOT.TB combined with ADA in the diagnosis of TPE.Methods From January 2019 to June 2019,102 patients with pleural fluid were enrolled retrospectively and categorized as diagnosis of tuberculous pleural effusion group(83 cases)and non-tuberculous pleural effusion group(19 cases)in Guangzhou Chest Hospital.Pleural effusion T-SOPT.TB and ADA were measured and the diagnostic value of two methods was compared.The ROC curve was used for statistical analysis.Results The diagnostic rate of ADA and pleural effusion T-SOPT.TB were 75.49%,92.16%,the sensitivities were 71.08%,97.59%,and the specificities were 94.74% and 73.68%,respectively.The diagnostic rate of combined group was 93.14%.Area under the ROC curve of T-SOPT.TB,ADA and combined group were 0.829(CI95%,0.741~0.917),0.856(CI95%,0.735~0.978),0.862(CI95%,0.741~0.983),respectively.The diagnostic efficacy of combination group was higher.Conclusion The combined detection of pleural effusion T-SOPT.TB and ADA of hydrothorax is more valuable than that of single detection,which is helpful to the early diagnosis.Part ? Diagnostic value of combined pleural biopsy with pleural effusion T-SOPT.TB in tuberculous pleural effusion Background and Objective Studies have shown that mononuclear cells in special infection sites have higher IFN ? release response than peripheral blood mononuclear cells.Therefore,TPE based on IFN ? release test in pleural effusion T-SOPT.TB has more outstanding diagnostic value than blood T-SOPT.TB.Considering that closed thoracentesis is needed to relieve the symptoms of TPE,and there is an urgent need to explore the cross-sectional study of the clinical pathway of TPE.This part will analyze the diagnostic value of pleural biopsy combined with pleural effusion T-SOPT.TB for tuberculous pleural effusion.Methods The research objects were 178 patients suspected of tuberculosis pleural effusion from January 2019 to June 2019 in Guangzhou Chest Hospital.131 cases were confirmed with tuberculous pleural effusion and 47 cases with non-tuberculous pleural effusion.The pleural effusion were collected to be detected by the pleural effusion T-SPOT.TB and the pleural biopsy.Statistic methods were used to analysis all the results.Results The sensitivity,specificity,positive predictive value and negative predictive value of pleural biopsy were 62.59%,100%,100% and 48.95%,respectively.The pleural effusion T-SOPT.TB had 83.97% sensitivity,80.85% specificity,92.97% positive predictive value and 76.00% negative predictive value.Furthermore,combined pleural biopsy and pleural effusion T-SOPT.TB detection improved the sensitivity to 97.71% with the specificity up to 80.85%.Area under the ROC curve of pleural biopsy,pleural effusion T-SOPT.TB and combined group were 0.813(CI95%,0.753~0.873),0.858(CI95%,0.787~0.930),0.889(CI95%,0.820~0.958),respectively.The diagnostic efficacy of combination group was higher.Conclusion The combination of pleural effusion T-SOPT.TB and biopsy has a promising prospect in the clinical practice of tuberculous pleural effusion.Part ? Risk factors for poor prognosis of tuberculous pleural effusionBackground and Objective Generally speaking,pleural effusion will gradually decrease and improve after 6 weeks of TPE antituberculosis treatment.But from the literature reports and our clinical practice,the prognosis of TPE are different.After antituberculosis treatment,TPE can still cause pleural adhesions,encapsulated effusions,pleural tuberculomas,pleural fibrosis or empyema in some patients,resulting in the pulmonary function decline and serious influence in quality of life.What is often referred to as poor prognosis of tuberculous pleural effusion.In addition,the treatment of TPE also faces new challenges,such as the increase of drug-resistant tuberculosis,the combination of HIV infection and other diseases that affect the immune function of the body,which may lead to an increase in the incidence of the poor prognosis.Therefore,clinicians should pay more attention to the risk factors for poor prognosis of TPE,so as to reduce the incidence of the poor prognosis by comprehensively using different intervention strategies on the basis of anti tuberculosis standard program.The purpose of this part is to study the clinical characteristics of TPE and find the risk factors for poor prognosis of TPE.Methods A retrospective analysis of the patients diagnosed with tuberculous pleural effusion(TPE)for the first time in Guangzhou Chest Hospital.According to the prognosis,the patients were divided into poor prognosis group and good prognosis group for comparative analysis.The multivariate logistic regression analysis was used for risk factors of poor prognosis.Results A total of 242 patients were included in this investigation,with male 196,female 46,average age of(37.67±15.99)years old.111 patients 45.87%(111/242)were poor prognosis group.Single factor analysis showed that the following factors were significantly different between the two groups: course of disease,bilateral pleural effusions,amount of pleural fluid,reticular septation(ultrasound signs),pleural thickening,D-dimer,C-reactive protein,serum lactate dehydrogenase,pleural fluid Lymphocyte percentage,pleural fluid lactate dehydrogenase,pleural fluid sugar,pleural fluid adenosine deaminase and drug resistance.5.37%(13/242)were drug-resistant TPE.Multivariate logistic regression analysis showed that bilateral pleural effusions,reticular septation(ultrasound signs),pleural fluid lactate dehydrogenase and drug resistance were the risk factors.According to the four risk factors mentioned above,a risk assessment model was established.Area under the ROC curve was 0.867(95% CI,0.821-0.913).Conclusion The incidence of poor prognosis is not low.Bilateral pleural effusions,reticular septation(ultrasound signs),pleural fluid lactate dehydrogenase and drug resistance are the risk factors of poor prognosis of TPE.