荧光定量PCR检测在结核性胸腔积液中的诊断价值

Diagnositic value of fluorescence quantitative PCR detection in tuberculous pleural effusion

目的研究实时荧光定量PCR在结核性胸腔积液中的诊断价值。方法收集从2021年1月至2022年5月期间孝感市中心医院98例患者的胸水,患者入院后均行胸水PCR、胸水ADA、外周血T-SPOT,并以胸腔镜活检或临床诊断为诊断金标准,计算PCR独立及联合检测对结核性胸腔积液的诊断价值。结果胸水PCR诊断结核性胸腔积液的敏感性为53.8%,低于胸水ADA及外周血T-SPOT的敏感性(P<0.05);胸水PCR特异性最高,与胸水ADA、外周血T-SPOT相比,差异有统计学意义(P<0.05);当胸水PCR、胸水ADA及外周血T-SPOT并联诊断时,诊断结核性胸腔积液的敏感性最高,占比高达96.2%。结论胸水PCR在结核性胸腔积液诊断中,敏感性适中,但特异性较高,三者并联检测时敏感性最高,可减少漏诊率;两者或三者串联检测可提高胸水ADA及外周血T-SPOT的特异性,减少误诊率。

【Objective】To study the diagnostic value of real-time fluorescence quantitative PCR in tuberculous pleural effusion.【Methods】The pleural effusion of 98 patients in our hospital from January 2021 to May 2022 were collected.After admission,all patients underwent pleural effusion PCR,pleural effusion ADA and peripheral blood T-SPOT.The independent and combined diagnostic value of PCR in tuberculous pleural effusion was calculated with thoracoscopic biopsy or clinical diagnosis as the diagnostic gold standard.【Results】First,the sensitivity of PCR in the diagnosis of tuberculous pleural effusion was 53.8%,which was lower than that of ADA in pleural effusion and T-SPOT in peripheral blood,with statistical significance(P<0.05).Secondly,the specificity of PCR in pleural effusion was the highest,which was statistically significant compared with ADA in pleural effusion and T-SPOT in peripheral blood(P<0.05).Finally,when pleural effusion PCR,pleural effusion ADA and peripheral blood T-SPOT were used in parallel diagnosis,the sensitivity of diagnosis of tuberculous pleural effusion was the highest,accounting for 96.2%.【Conclusion】The sensitivity of pleural effusion PCR is low in the diagnosis of tuberculous pleural effusion,but the specificity is high,and the sensitivity of the three methods in parallel is the highest,which can reduce the missed diagnosis rate.Serial detection of two or three can improve the specificity and reduce the misdiagnosis rate.