胸腔积液ADA联合外周血T-SPOT.TB、D-二聚体对结核性胸膜炎的早期诊断价值

Value of pleural effusion ADA combined with peripheral blood T-SPOT.TB and D-dimer in early diagnosis of tuberculosis pleurisy

目的:探讨胸腔积液腺苷脱氨酶(adenosine deaminase,ADA)、结核感染T细胞斑点实验(tuberculosis infection T-cell spot test,T-SPOT.TB)、D-二聚体(D-dimer,D-D)联合检测对结核性胸膜炎(tuberculosis pleurisy,TPE)的早期诊断价值。方法:选取2021年1月—2023年12月南通市第六人民医院收治住院患者118例,其中TPE患者62例为TPE组,非结核性胸膜炎患者56例为非结核性胸膜炎(non-tuberculous pleurisy,NTPE)组。分别检测和比较两组胸腔积液中ADA含量、外周血T-SPOT.TB试验中ESAT6、CFP10斑点孔数及D-D水平,比较不同指标之间的差异性及相关性。应用ROC曲线分析上述指标对TPE的早期诊断价值。结果:TPE组胸腔积液ADA含量、外周血ESAT6、CFP10斑点孔数以及D-D水平分别为[38.95(24.92,49.17)U·L^(-1)、20.00(12.75,40.00)孔、20.00(8.50,40.00)孔、3.52(1.99,5.95)mg·L^(-1)],与NTPE组[10.55(7.35,16.57)U·L^(-1)、1.00(0.00,4.00)孔、0.00(0.00,4.00)孔、1.17(0.74,2.29)mg·L^(-1)]相比均明显升高(Z=-6.405、-5.411、-6.517、-6.468,均P<0.001)。TPE组外周血ESAT6、CFP10斑点孔数与胸腔积液ADA含量均呈中度正相关(r=0.596、0.581,均P<0.001),而外周血ESAT6、CFP10斑点孔数与D-D水平则呈低度正相关(r=0.398、0.443,均P<0.001)。胸腔积液ADA、外周血ESAT6、CFP10及D-D早期诊断TPE的ROC曲线的AUC分别为0.842、0.845、0.840、0.789。上述4种指标联合检测的AUC为0.960,敏感度和特异度分别为87.1%和96.43%,均高于单个指标。结论:TPE患者胸腔积液ADA含量、外周血ESAT6、CFP10斑点孔数及D-D水平均升高,联合诊断可提高TPE的诊断效果,有助于临床早期诊断TPE。

Objective:To explore the early diagnostic value of pleural effusion adenosine deaminase(ADA)combined with peripheral blood tuberculosis infection T-cell spot test(T-SPOT.TB)and D-dimer(D-D)in tuberculosis pleurisy(TPE).Methods:Total of 118 inpatients in the Sixth People's Hospital of Nantong from January 2021 to December 2023 were enrolled in this study and divided into a group(62 cases)with TPE patients and a group(56 cases)with non-tuberculosis pleurisy(NTPE)patients.The levels of pleural effusion ADA,peripheral blood T-SPOT.TB(ESAT6 and CFP10 wells)and D-D were measured.The differences and correlations in all indicators were analyzed between the two groups.The ROC curve was applied to evaluate the sensitivity and specificity of these indicators in the early diagnosis of tuberculosis pleurisy.Results:The levels of pleural effusion ADA,peripheral blood ESAT6,CFP10 wells and D-D from the TPE group were 38.95(24.92,49.17)U·L^(-1),20.00(12.75,40.00)wells,20.00(8.50,40.00)wells,and 3.52(1.99,5.95)mg·L^(-1)respectively,which were significantly higher than corresponding[10.55(7.35,16.57)U·L^(-1),1.00(0.00,4.00)wells,0.00(0.00,4.00)wells and 1.17(0.74,2.29)mg·L^(-1)]in the NTPE group(Z=-6.405,-5.411,-6.517,-6.468,all P<0.001).Furthermore,the levels peripheral blood ESAT6 and CFP10 wells had moderate positive relationship with the level of pleural effusion ADA in the TPE group(r=0.596,0.581,both P<0.001).And the levels peripheral blood ESAT6 and CFP10 wells had low positive relationship with the level of D-D(r=0.398,0.443,both P<0.001).The AUC of ROC curve of pleural effusion ADA,peripheral blood ESAT6,CFP10 wells and D-D for early diagnosis of TPE were 0.842,0.845,0.840,0.789 respectively.In addition,the AUC obtained by simultaneous measurement of ADA,ESAT6,CFP10 wells and D-D was as high as 0.960,and the sensitivity and specificity of diagnosing TPE were 87.1%and 96.43%,which were higher than any individual indicator.Conclusion:The levels of pleural effusion ADA,peripheral blood ESAT6、CFP10 wells and D-D all show varying degrees of increase in the TPE patients,and can assist in early diagnosis of TPE.