Clincal Significance Of MLR、PADA And Pldh In The Diagnosis Of Tuberculous Pleural Effusion

Objective:To explore the diagnostic value of monocyte to lymphoid ratio(monocyte to lymphoid ratio MLR),(pleural adenosine deaminase(Pleural adenosine deaminase,PADA)and pleural lactate dehydrogenase(Pleural lactate dehydrogenase,PLDH)in tuberculous pleural effusion.Methods:A total of 167 patients who met the diagnostic criteria of pleural effusion and were hospitalizedin the affiliated Hospital of Yanbian University from January 2010 to December 2020 were analyzed retrospectively,including 38 cases of malignant pleural effusion(Malignant pleural effusion,MPE)and 139 cases of tuberculous pleural effusion(Tuberculosis Pleural Effusions,TPE)in Yanji Cancer Hospital,all of them were confirmed by cytology or pathology.The basic data of the two groups were collected and the results of MLR,PADA,PLDH,hs-CRP and PLDH/ADA were collected within 24 hours of admission.ROC curve was used to analyze the clinical value of PLDH,PADA and MLR in the diagnosis of tuberculous pleural effusion.Results:The conclusions of this study are as follows:the gender and age difference between the TPE group and the MPE group is statistically significant(p<0.01);MONO count,PLT count,MLR,LDH,ADA and hs-CRP expression levels in TPE group were significantly higher than those in MPE group,with statistical differences(p<0.05),while there were no statistical differences in PLDH/PADA,NLR and PLR between the two groups(p>0.05).Correlation analysis between the two groups showed significant correlations between MLR and cell count,PLDH,PADA and hs-CRP.Univar ate analysis showed that MLR was positively correlated with PLDH,PADA,hs-CRP,and negatively correlated with cell count in TPE group.Multivariate analysis showed that MLR was positively correlated with lobulated cells,PLDH,PADA and hs-CRP(p<0.001),and negatively correlated with lymphocyte percentage.In the two groups of TPE and MPE,each index used the same critical value,and there were significant differences in MLR,PADA and PLDH between the two groups.According to the Yoden coefficient,the optimal thresholds of MLR,PLDH and PADA for TPE diagnosis were determined.The areas under the curve(AUC)of the optimal thresholds for these three indexes were 0.675,0.814 and 0.897,respectively.When the critical level of MLR is set at 0.66,the sensitivity is 46.1%,and the specificity is 84.61%.When the critical level of 353U/L is set at the level of 353U/L,the sensitivity is 83.5%,and the specificity is 61.86%.When the critical level of PADA is set at the level of 32.9U/L,the sensitivity is 82.81%,and the specificity is 84.62%.Among the three indicators,ADA is the best for single detection,the area under the ROC curve is 0.897,the sensitivity is 82.8%,and the specificity is 84.6%.For the two tests,LDH+ADA is the best,the sensitivity is 80.47%,the specificity is 89.74%.MLR+ADA+LDH,the sensitivity is 78.12%,and the specificity is 92.31%.The critical value of PAD A to 29.6U/L is established for the first time.When the value was 353,the highest specificity and positive predictive value(PPV)respectively were 78.49%and 97%,but the sensitivity and negative predictive value(NPV)respectively decreased to 78.91%and 53.44%.Conclusions:1.Serum MLR,PADA and PLDH have certain clinical reference value in the diagnosis of TPE,and the combined detection of the three indexes can improve the specificity and sensitivity of diagnosis.2.Compared with MPE group,MLR,PLDH and PADA were significantly increased in TPE group,which can be used as a predictor of TPE diagnosis.