胸水腺苷脱氨酶联合血结核感染T细胞斑点试验在中青年和老年结核性胸膜炎诊断中的价值对比

The value comparison on ADA of pleural fluid combined with blood T-SPOT.TB in the diagnosis for tuberculous pleurisy between young and middle-aged patients and senile patient

目的:比较胸水腺苷脱氨酶(ADA)联合血结核感染T细胞斑点试验在中青年和老年结核性胸膜炎(TBP)中的诊断价值。方法:回顾性分析医院呼吸内科疑诊为TBP的105例患者临床资料,所有患者均行内科胸腔镜与血结核感染T细胞斑点试验检查,经组织病理学确诊。按照最终诊断结果将患者分为TBP组(80例)和非TBP组(25例);再将105例患者按照年龄段的不同分组,将年龄≥60岁患者分为老年组(38例),将年龄为18～59岁患者分为中青年组(67例)。比较胸水ADA联合血结核感染T细胞斑点试验在中青年和老年疑诊为TBP中的受试者工作特征(ROC)曲线下面积(AUC),计算其诊断的灵敏度和特异度。结果:老年组中结核感染T细胞斑点试验对TBP诊断的灵敏度和特异度分别为81.58%和70.15%,AUC为0.76;中青年组中分别为85.07%和73.68%,AUC为0.81,两组诊断效能的比较差异无统计学意义(x^2=0.81,P>0.05)。老年组中胸水ADA联合血结核感染T细胞斑点试验对TBP诊断的灵敏度和特异度分别为97.37%和91.04%,AUC为0.90;中青年组中分别为98.51%和94.74%,AUC为0.94,两组疑诊TBP诊断效能的比较,差异无统计学意义(x^2=1.23,P>0.05)。结论:胸水ADA联合血结核感染T细胞斑点试验可明显增强对各年龄段TBP患者的诊断价值,尤其对难以耐受胸膜组织活检的老年患者而言,更具有临床应用价值。

Objective： To compare the diagnostic value of adenosine deaminase （ADA） of pleural fluid combined with spot test of T cells infected with Mycobacterium tuberculosis（T-SPOT.TB） in diagnosis for tuberculous pleurisy （TBP） between young and middle-aged patients and elderly patients. Methods： The clinical data of 105 patients who were suspected TBP in the respiratory department of our hospital were retrospectively analyzed. All of them underwent the examinations of thoracoscopy and T-SPOT.TB for blood tuberculosis infection, and they were confirmed by histopathology. And all of patients were divided into TBP group （80 cases） and non-TBP group （25 cases） according to the final diagnosis results. On the other hand, they were divided into senile group （38 cases whose ages were more than 60 years ） and young and middle-aged group （67 cases whose ages were between 18-59 years） according to different ages. The AUC of ROC about pleural fluid adenosine deaminase （ADA） combined with T-SPOT.TB between the two groups were compared, and the sensitivity and specificity of this combined method were calculated. Results： In senile group, the sensitivity and specificity of T-SPOT.TB for the diagnosis of TBP were 81.58% and 70.15%, respectively, and its AUC was 0.76. And they were 85.07% and 73.68% in the young and middle-aged group, respectively, and its AUC was 0.81. There was no significant difference in the diagnostic efficacy between the two groups （χ^2=0.81, P〉0.05）. The sensitivity and specificity of pleural fluid ADA combined with blood T-SPOT.TB in the elderly group were 97.37% and 91.04% respectively, and its AUC was 0.90. Those in the young and middle-aged group were 98.51% and 94.74% respectively, and its AUC was 0.94. There was no significant difference in the diagnostic efficacy for suspected TBP between the two groups （χ^2=1.23, P〉0.05）. Conclusion： The combined examination of pleural fluid ADA and T-cell spot test can significantly strengthen the diagnostic value of TBP for patients in different age stage, especially for senile patients who can＇t tolerate pleural biopsy, which has more clinical application value.