胸腔积液γ-干扰素释放试验对老年结核性胸膜炎诊断及预后预测价值

Clinical Significance of Interferon-gamma Release Assay in Diagnosis and Prediction of Prognosis of Tuberculous Pleurisy in the Elderly

目的探讨胸腔积液γ-干扰素释放试验(interferon-gamma releasing assay,IGRAs)对老年结核性胸膜炎(tuberculous pleurisy,TP)患者的诊断及预后预测价值。方法选取老年胸腔积液143例,根据临床确诊结果将其分为TP组(75例)和非TP组(68例)两组。后排除2例中途放弃治疗和3例转院治疗的老年TP患者,根据不同胸腔积液排净时间将老年TP患者分为1~3个月组(26例)、3~4个月组(21例)和≥4个月组(23例),根据是否胸膜增厚将老年TP患者分为胸膜增厚组(31例)和胸膜未增厚组(39例)两组。比较TP组和非TP组,1~3个月组、3~4个月组和≥4个月组,以及胸膜增厚组和胸膜未增厚组胸腔积液结核感染T细胞斑点试验(T cell spot test of tuberculosis infection,T-SPOT.TB)及生化检测结果;并应用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析胸腔积液T-SPOT.TB检测斑点形成细胞(spots forming cells,SFC)对老年TP患者的诊断和预后预测价值。结果TP组胸腔积液IGRAs阳性率92.00%高于非TP组胸腔积液IGRAs阳性率58.82%,差异有统计学意义(P<0.01);TP组胸腔积液SFC和淋巴细胞、蛋白、乳酸脱氢酶、C反应蛋白(C reactive protein,CRP)均高于非TP组,差异有统计学意义(P<0.01)。1~3个月组、3~4个月组和≥4个月组3组胸腔积液SFC和淋巴细胞、CRP总体比较差异均有统计学意义(P<0.01)。胸腔积液SFC和淋巴细胞、CRP≥4个月组高于1~3个月组和3~4个月组,胸腔积液SFC 3~4个月组高于1~3个月组,差异有统计学意义(P<0.05或P<0.01)。胸膜增厚组胸腔积液SFC和淋巴细胞、CRP明显高于胸膜未增厚组,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,胸腔积液T-SPOT.TB检测SFC诊断老年TP的曲线下面积(area under the curve,AUC)为0.968,最佳截断值为212.05个,此截断值下诊断老年TP的灵敏度和特异度分别为92.00%和94.12%;预测老年TP预后的AUC为0.813,最佳截断值为1405.25个,此截断值下预测老年TP预后的灵敏度和特异度分别为87.10%和82.05%。结论胸腔积液IGRAs在老年TP的诊断和预后预测中均具有较高的临床价值,可以作为老年TP辅助诊断和预后判断的方法。

Objective To explore the value of interferon gamma release assay(IGRAs)in the diagnosis and prediction of prognosis of tuberculous pleurisy(TP)in the elderly.Methods A total of 143 elderly patients with pleural effusion were divided into TP group(n=75)and non-TP group(n=68)according to results of clinical diagnosis.Two TP patients who gave up halfway and 3 cases who were transferred to other hospitals were excluded.According to different drainage time of pleural effusion,the elderly TP patients were divided into 1-3 months group(n=26),3-4 months group(n=21)and≥4 months group(n=23).According to presence or absence of pleural thickening,the elderly TP patients were divided into pleural thickening group(n=31)and non-pleural thickening group(n=39).The T-cell spot test of tuberculosis infection(T-SPOT.TB)and biochemical test results were compared between TP group and non-TP group,between 1-3 months group,3-4 months group and≥4 months group,as well as between pleural thickening group and non-pleural thickening group.The diagnostic and prognostic value of T-SPOT.TB for detection of spot forming cells(SFC)in elderly TP patients were analyzed by using receiver operating characteristic curve(ROC).Results The positive rate of IGRAs in TP group was 92.00%,which was higher than that in non-TP group(58.82%)(P<0.01).The SFC,lymphocyte,protein,LDH and C-reactive protein(CRP)in pleural effusion of TP group were significantly higher than those of non-TP group(P<0.01).There were statistically significant differences in SFC,lymphocyte and CRP in pleural effusion between 1-3 months group,3-4 months group and≥4 months group(P<0.01).The levels of SFC,lymphocyte and CRP in patients with pleural effusion≥4 months were higher than those with pleural effusion 1-3 months and 3-4 months,and the levels were higher in patients with pleural effusion 3-4 months than those with pleural effusion 1-3 months(P<0.05 or P<0.01).The SFC,lymphocyte and CRP of pleural effusion in pleural thickening group were significantly higher than those in non-pleural thickening group(P<0.01).The results of ROC analysis showed that the area under the curve(AUC)of T-SPOT.TB for TP diagnosis by detecting SFC was 0.968,and the optimal cutoff value was 212.05.The sensitivity and specificity of this cutoff value were 92.00% and 94.12%,respectively.The AUC of T-SPOT.TB in pleural effusion in predicting the prognosis of TP in the elderly was 0.813,the optimal cutoff value was 1405.25,and the sensitivity and specificity were 87.10% and 82.05% respectively.Conclusion IGRAs is of high value in the diagnostic and prognostic prediction of TP in the elderly,which,therefore,can be used as an auxiliary method in diagnosis and prognosis judgment of TP in the elderly.