Dignostic Significance Of The Combination Detection Of ADA And Nucleated Cell Count In Tuberculous Pleurisy And Parapneumonic Effusion

ObjectiveTuberculousis pleurisy and parapneumonic effusion is a common cause of pleural effusion caused by clinical,but the current laboratory identification of the two estimates of pleural effusion is insufficient.Therefore,the purpose of this study is to detect the clinical value of combined detection of tuberculousis pleurisy and parapneumonic pleural effusion by detecting the level of adenosine deaminase(ADA)and nucleated cell count in pleural effusion.MethodsA total of 175 patients with pleural effusion admitted to the Department of Respiratory Medicine,Shandong Provincial Hospital from December 2010 to March 2017 were collected.Among them.64 cases of’ tuberculousis pleurisy clinical diagnosed or diagnosed by thoracoscopic biopsy.41 cases of parapneumonic pleural effusion,54 cases of malignant pleural effusion,other causes(low albuminemia,pulmonary embolism,connective tissue disease related,parasites)caused pleural effusion in 16 cases.To compare the levels of ADA and nucleated cells count in different types of pleural effusion and evaluate the value of ADA and nucleated cell count for tuberculousis pleurisy and parapneumonic pleural effusion by using ROC curve.Results1.Comparison and analysis of ADA level in pleural effusion with different properties The ADA of pleural effusion in patients with tuberculousis pleurisy was 36.9 土10.7U/L;the ADA of parapneumonic pleural effusion was 56.7± 15.8U/L;the ADA level of malignant pleural effusion was 11.6±3.5U/L。The level of ADA in parapneumonic pleural effusion was significantly higher than that in tuberculousis pleurisy group and malignant pleural effusion group,and the tuberculousis pleurisy group was significantly higher than that of malignant pleural effusion group.the three were statistically significantly different2.Comparison and analysis of nucleated cell count of pleural effusion with different propertiesThe number of nucleated cel]s in the tuberculousis pleurisy was 2951.5±375.2*J0^6/L:the number of nucleated cells in the parapneumonic pleural effusion was 35858.3±1679.3*10^6/L;The nucleated cell count of the malignant pleural effusion group was 2279.9 士 269.3*10^6/L.The counts of nucleated cells in parapneumonic pleural effusion were significantly higher than those in tuberculousis pleurisy and malignant pleural effusion group,and there was no significant difference between tuberculousis pleurisy group and malignant pleural effusion group.3.ADA combined with nucleated cell count(AUC = 0.826)was superior to the single detection of nucleated cell count(AUC = 0.477)(P<0.05)with the sensitivity of 1-specific x-axis,sensitivity to y-axis roc curve.There was no significant difference with ADA(AUC = 0.776)(p>0.05).ADA detection of tuberculousis pleurisy value is 18.15U/L,at this time the detection sensitivity of tuberculousis pleurisy is 0.891.specificity of 0.695;nucleated cell count for the diagnosis of tuberculousis pleurisy is of little significance4.ADA combined with nucleated cell count(AUC = 0.724)was superior to that of ADA alone(AUC = 0.626)(p<0.05).However,the difference was not significant with that of nucleated cell count alone.(P>0.05)The The best diagnostic threshold was 6249.5*10^6/L,and the sensitivity was 0.512 and the specificity was 0.932.The optimal diagnostic value of ADA was 63U/L,the sensitivity was 0.317 and the specificity was 0.975.5.According to the threshold value of ADA and nucleated cell count obtained from roc curve,the two indexes were found to be:18.15U/L<ADA<63U/L and the nucleated cell count was<6250*10^6/L The sensitivity and specificity of diagnosis of tuberculousis pleurisy were 96.9,the positive predictive rate was 95.4,the negative predictive rate was 97.9;ADA>63U/L and the nucleated cell count ≥6250*10^6/L for the diagnosis of parapneumonic effusion,the sensitivity of pleural effusion was 21.9,the specificity was 95.8,the positive predictive rate was 64.3,the negative predictive rate was 77.9;ADA≤18.15U/L and the nucleated cells less than 6250*10^6/L for the diagnosis of malignant pleural effusion,the sensitivity was 88.9,the specificity was 82.6,the positive predictive rate was 70.6,and the negative predictive rate was 94.1.Conclusion:1.The use of pleural effusion laboratory examination for the early dignosis of pleural effusion still has very high practical value.The use of a single indicator of pleural effusion to identify its unexplained pleural effusion nature has some limitations,but the joint use of limited indicators can improve diagnostic performance to a certain state.2.Using the thehold calculated from ROC curve to analyze the combined use of ADA with nucleated cell count,the sensitivity and specificity of diagnosis of tuberculousis pleurisy were 96.9%,and the positive and negative predictive rates reached 95.4 and 97.9,this is worthy of clinical application promotion.3.ADA level in parapneumonic effusion was significantly higher than that in tuberculousis pleurisy.4.The critical value of ADA in the diagnosis of tuberculousis pleurisy was 18.5U/L,which was lower than that of ADA>40U/L.The similar results can be found in domestic and foreign research.5.In the diagnosis of parapneumonic pleural effusion,nucleated cell count showed a high specificity,worthy of clinical attention,and a large sample size analysis to obtain a more accurate diagnostic threshold.