TB—IGRA联合胸膜活检在结核性胸膜炎诊断中的临床应用

目的评价联合利用外周血结核感染T细胞体外释放酶链免疫试验（TB—IGRA）以及胸腔镜胸膜活组织病理检查在疑似结核性胸膜炎中的辅助诊断价值。方法采集116例疑似结核性胸膜炎伴胸腔积液患者的外周血进行TB-IGRA检测，同时行胸腔镜胸膜活组织病理检查。采集胸膜组织做病理检查，采集胸腔积液做ADA检测，对各组数据进行统计学处理与分析。结果116例患者按照结核性胸膜炎诊断标准，结合相关实验室及辅助检查，临床确诊结核性胸膜炎组病例45例。TB-IGRA对于结核性胸膜炎的检测阳性率为71．1％，其诊断结核性胸膜炎的灵敏度、特异度及阳性预测值分别为62．2％、87．9％和87．5％。胸腔镜胸膜活检病理结果为阳性20例，阳性率为44．4％。联合TB-IGRA和胸膜活检的检测阳性率为91．1％，其诊断结核性胸膜炎的灵敏度、特异度及阳性预测值分别为88．9％、97．0％和97．9％。结核性胸腔积液组检测ADA的结果明显高于其它两组检测结果，差异有统计学意义（P均〈0．05）。结论TB-IGRA联合胸腔镜胸膜活组织病理检查对于临床呼吸内科快速定性结核性胸腔积液及结核性胸膜炎的确诊具有重要的辅助诊断价值。

Objective To evaluate the diagnostic value about combination of peripheral blood TB-IGRA and pleural biopsy in patients with tuberculosis pleurisy. Methods The research objects were 116 patients suspected of tuberculosis pleurisy with pleural effusion. The peripheral blood were collected to be detected by the TB-IGRA, and the pleural biopsy were performed under thoracoscopy to obtain the pleura tissue in order to do pathological examination. The ADA was used to be detected in pleural effusion, and statistic methods were used to analysis all the results. Results Under the diagnostic criteria of tuberculosis pleurisy, and combined with related examination, the final 45 patients which were diagnosed as tuberculosis pleurisy. The positive rate detected by TB-IGRA as tuberculosis pleurisy was 71.1%, it＇ s sensitivity, specificity, negative and positive predictive value were 88.9%, 97.0%和97.9% respectively.The number of tuberculosis pleurisy which were diagnosed by pathological examination was 20 cases, and the positive rate was 44.4%.The positive rate of the combined detection of TG-IGRA and pleural biopsy was 91.1%, and the sensitivity, specificity, negative and positive predictive value were 88.9%、 97.0%和97.9% respectively.There were different values about ADA which was detected in different kinds of pleural effusion. The ADA of tuberculous pleural effusion group were higher than the other two groups, There was statistical significance among these results （P〈0.05） . Conclusions The combined detection of TB-IGRA and p leural biopsy with thoracoscopy has important assisting diagnostic value for respiratory physician to diagnose tuberculosis pleurisy accurately.