T-SPOT.TB Assay Analysis Of Clinical Value In The Differential Diagnosis Of Exudative Pleural Effusion

Objective:This study through the detection of patients of pleural effusion with tuberculosis infection T-SPOT.TB assay,and pleural fluid ADA activity,PPD reagent for tuberculin skin test,comparison of the three test results,to explore the application value of T-SPOT.TB test in differential diagnosis of tuberculous and non-tuberculous pleural effusion.Methods:87 pleural effusion patients of unknown origin cause since July 2015 to July 2016 from the First Affiliated Hospital of Wangnan Medical College yijishan hospital were enrolled in this prospective cohort study,according to the final diagnosis and follow-up,get rid of 3 pepole who are gaven indeterminate results,finished 84 cases.According to the pleural effusion and pathology laboratory diagnosis,including 55 patients with tuberculous pleural effusion(among them 1 case of sputum smear-positive,14 case of pathological diagnosis)and 29 patients with non-tuberculous pleural effusion.All patients underwent peripheral blood T-SPOT.TB assay,PPD test,pleural fluid ADA detection,and the sensitivity,the specificity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio of various methods were detected according to the test results,and scientific assessment the clinical diagnostic value of the various test methods according to the receiver operating characteristic curve.Results:87 cases of pleural effusion in 3 patients with uncertain results,the final results of the 84 cases,55 patients were dignosised with tuberculosis pleural effusion,and 29 patients were dignosised with no-tuberculosis pleural effusion.55 cases of tuberculous pleural effusion in patients with peripheral blood T-SPOT.TB,PPD test,pleural effusion of ADA positive patients were 48 cases,37 cases,47 cases;29 cases of non-tuberculous pleural effusion in patients with peripheral blood T-SPOT.TB,PPD test,pleural effusion of ADA positive patients were 4 cases,10 cases,3 cases.Including peripheral blood T-SPOT.TB,PPD test,pleural effusion ADA test,this three kinds of methods for the sensitivity of the diagnosis of tuberculous pleural effusion were 87.27%,67.27%,85.45%,specificity of 86.20%,65.51% and 89.82% respectively;the positive predictive value were 92.3%,78.72%,94%,negative predictive value of 78.13%,51.35% and 76.47% respectively;positive likelihood ratio were 6.32,1.95,8.39,and negative likelihood ratio were 0.15,0.50,0.16.The sensitivity,specificity,positive predictive value,negative predictive value of three tests were disposed of X2 test and chi square values were 7.056(P=0.029),6.287(P=0.043),6.686(P=0.035),7.337(P=0.026).The peripheral blood T-SPOT.TB for diagnostic efficacy of tuberculous pleural effusion was higher than that of PPD test(X2=5.329,P=0.021),the difference has statistical significance;the diagnostic efficacy of pleural effusion ADA detection for tuberculous pleural effusion was also higher than that of PPD test(X2=4.193,P=0.041),the difference has statistical significance;the result of peripheral blood T-SPOT.TB and pleural fluid ADA test has no statistical significance(X2=0.077,P=0.781).The ROC area,sensitivity,specificity,cut-off value and Youden index of this three tests were0.874?87.3%?86.2%?15?0.77;0.767?67.3%?69%?6.5?0.363;0.876?85.5%?86.2%?21.95?0.752?Conclusion:(1)T-SPOT.TB test can be used in the diagnosis of tuberculous pleural effusion,with high sensitivity and specificity.(2)The efficacy of T-SPOT.TB in the diagnosis of tuberculous pleural effusion was similar to that of pleural fluid ADA test.Combined determination might be useful to improve the diagnostic level.(3)The efficacy of T-SPOT.TB in the diagnosis of tuberculous pleural effusion was significantly higher than that of PPD test.