胸腔积液y-干扰素释放试验对老年结核性胸膜炎的诊断价值

Diagnostic value of pleural effusion detected with IGRA in the elderly with tuberculous pleurisy

目的 评价胸腔积液y-干扰素释放试验（interferongammareleaseassay，IGRA）对老年结核性胸膜炎（pleuraleffusion，PE）的诊断价值。方法选取2013年1月至2015年7月在河北省胸科医院结核内科疑似为结核性胸膜炎的133例老年住院患者，同时进行胸腔积液和外周血的IGRA，依据最终结果将患者分为确诊结核性胸膜炎组（简称“确诊组”）、临床诊断结核性胸膜炎组（简称“临床诊断组”）、非结核性胸膜炎组，比较各组胸腔积液和外周血IGRA的敏感度与特异度、阳性预测值与阴性预测值。结果13例（9．77％）确诊为结核性胸膜炎，63例（47．37％）临床诊断为结核性胸膜炎，57例（42．86％）为非结核性胸膜炎。胸腔积液IGRA的敏感度为90．79％（69／76），明显高于外周血的67．11％（51／76），差异有统计学意义（X2=12．826，P〈0．001）；胸腔积液IGRA的特异度为98．25％（56／57），明显高于外周血的84．21％（48／57），差异有统计学意义（X2=7．015，P=0．016）；胸腔积液IGRA的阳性预测值为98．57％（69／70），高于外周血的85．00％（51／60），差异有统计学意义（X2=8．380，P〈0．001）；胸腔积液IGRA的阴性预测值为88．89％（56／63），明显高于外周血的65．75％（48／73），差异有统计学意义（X2=10．059，P=0．002）。结论与外周血IGRA相比，胸腔积液IGRA可大幅提高对老年结核性胸膜炎的敏感度和特异度、阳性预测值和阴性预测值，明显提高对老年结核性胸膜炎的诊断水平。

Objective To evaluate the value of pleural effusion detected with interferomgamma release assay （IGRA） on diagnosis in the elderly with tuberculous pleurisy. Methods One hundred and thirty-three cases with suspected tuberculous pleurisy admitted in Hei Bei Chest Hospital were enrolled during Jan. 2013 to Jul. 2015. IGRA was tested for peripheral blood mononuclear cell （PBMC） and pleural effusion （PE）. All patients were divided into definite tuberculous pleurisy （confirmed group）, probable tuberculous pleurisy （clinical diagnostic group） and non-tuberculous pleurisy group according to the composite reference standard （CRS）. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of IGRA detected for PBMC and PE were compared, respectively. Results There were 13 （9.77%） cases with tuberculous pleurisy, 63 （47.37%） cases with probable tuberculous pleurisy and 57 （42.86%） cases with non-tuberculous pleurisy. The sensitivity （90.79%, 69/76） of IGRA for PE was higher than that （67.11%, 51/76） for PBMC with significant difference statistically （X2=12.826,P〈0.001）. The specificity （98.25%, 56/57） of IGRA for PE was higher than that （84.21%, 48/57） for PBMC with significant difference statistically （X2=7. 015, P= 0. 016）. The PPV （98.57 %, 69/70） and NPV （88.89%, 56/63） for PE were higher than those （85.00% ,51/60 and 65. 75% ,48/73） for PBMC with signifi cant difference statistically （X2-8. 380,P〈0. 001 and X2 = 10. 059,P=0. 002）. Conclusion Compared with the result of IGRA for PBMC, IGRA for PE can improve significantly the sensitivity, specificity, PPV and NPV and then improve significantly diagnostic level in the elderly with tuberculous pleurisy.