Genetic association study of P2x7 A1513C(rs 3751143) polymorphism and susceptibility to pulmonary tuberculosis: A meta-analysis based on the findings of 11 case-control studies

Objective:To summarize the precise association between pulmonary tuberculosis(PTB) and P2x7 A1513 C gene polymorphism.Methods:PubMed and Google Scholar web-databases were searched for the studies reporting the association of P2x7 A1513 C polymorphism and PTB risk.A meta-analysis was performed for the selected case-control studies and pooled odds ratios(ORs) and 95%confidence intervals(95%CIs) were calculated for all the genetic models.Results:Eleven studies comprising 2 678 controls and 2 113 PTB cases were included in this meta-analysis.We observed overall no significant risk in all the five genetic models.When stratified population by the ethnicity,Caucasian population failed to show any risk of PTB in all the genetics models.In Asian ethnicity,variant allele(C vs.A:P=0.001;QR=1.375,95%CI=1.159-1.632) and heterozygous genotype(AC vs.AA:P=0.001;OR=1.570,95%CI=1.269-1.944) demonstrated significant increased risk of PTB.Likewise,recessive genetic model(CC+AC vs.AA:P=0.001;OR=1.540,95%CI= 1.255-1.890) also demonstrated increased risk of PTB in Asians.Conclusions:Our meta-analysis did not suggest the association of P2x7 A1513 C polymorphism with PTB risk in overall or separately in Caucasian population.However,it plays a significant risk factor for predisposing PTB in Asians.Future larger sample and expression studies are needed to validate this association.

Pleural Fluid Alkaline Phosphate Levels to Differentiate between Tuberculosis and Malignant Pleural Effusion a Tertiary Care Experience

Introduction: Pleural effusion (PF) is a common clinical presentation in several diseases. Tuberculosis is one of the most frequent causes of exudative pleural effusions in immunocompetent patients. Tuberculosis is the leading cause of morbidity and mortality from an infectious disease in developing countries. Pakistan is ranked fifth in the world in terms of tuberculosis high-burden countries. Various pleural fluid parameters have been used to identify the cause of pleural effusion. It has been discovered that tuberculous pleural effusions had a greater alkaline phosphatase (ALP) concentration than transudative effusions. This study used pleural fluid alkaline phosphatase levels to distinguish between tuberculous pleural effusion and malignant pleural effusion because there is little information from tuberculosis-high burden nations like Pakistan. Study Design: A descriptive cross-sectional study conducted at the Jinnah Postgraduate Medical Center in Karachi between October 2016 and October 2017. Material and Methods: The study comprised all patients who were admitted to the department of chest medicine at Jinnah post graduate medical centre (JPMC) of either gender between the ages of 18 and 70 who had exudative lymphocytic pleural effusions lasting two weeks or more included in the study. Non probability consecutive sampling was used to collect data. Patients who have tonsillitis, pharyngitis, pneumonia, asthma, Chronic obstructive pulmonary disease (COPD), or a history of hemoptysis, Bleeding disorders like, platelet function disorder, thrombocytopenia, Liver cirrhosis and Pregnant women were excluded. Parents’ informed consent was obtained after being informed of the study’s protocol, hazards, and advantages. Each patient had their level of pleural fluid alkaline phosphate (PALP) assessed. In order to evaluate the patient’s pleural effusion, a pre-made questionnaire was used. All the collected data were entered into the SPSS 20. An independent sample t-test was used to recognize alkaline phosphate levels association with pleural fluid secondary to tuberculosis or malignancy. Results: In this Descriptive Cross-Sectional Study, the total of 156 patients with age Mean ± SD of was 41.96 ± 17.05 years. The majority of patients 110 (70.5%) were male and 46 (29.5%) were female. Advanced age was associated with raised pleural fluid alkaline phosphatase. The difference of pleural fluid alkaline phosphate level between tuberculous v/s malignant group was found to be (38.03 ± 45.97) v/s (82.77 ± 61.80) respectively with P-value (P = 0.0001). Conclusion: Malignant pleural effusions had elevated PALP when compared to tuberculous pleural effusions in exudative lymphocytic pleural effusions;better differences are seen in older ages and shorter disease durations.

Association of Genetic Polymorphism of GSTM1 and GSTT1 with the Susceptibility to Antituberculosis Drug-induced Hepatotoxicity in Chinese Population

Objective To investigate the relationship between the polymorphism of glutathione S transferase M1, T1(GSTM1, GSTT1) gene and the susceptibility to antituberculosis drug induced hepatotoxicity (ATDH) in patients with tuberculosis. Methods GSTM1 and GSTT1 gene polymorphisms in patients with or without liver toxicity after antituberculous treatment were analyzed using multiple PCR method. Results In ATDH group and control group, the proportion of GSTM1 gene deletion was 58.0% and 50.7% respectively, and the difference was not statistically significant (OR=1.322, 95%CI=0.921~1.878), the frequencies of GSTT1 deletion were 46.3% and 49.3%, respectively, and there was no significant difference between them. There was no significant difference in frequency of GSTM1 and GSTT1 variation between case group and control group (P> 0.05), and no synergistic effect of those two gene polymorphism were detected in the occurrence of antituberculosis drug-induced hepatotoxicity. Conclusion The polymorphisms of GSTM1 and GSTT1 genes may not be associated with the risk of ATDH.

Construction, Expression and Identification of a Recombinant BCG Vaccine Encoding Human Mycobacterium Tuberculosis Heat Shock Protein 65

Heat shock protein 65 (HSP65) is one of the most important protective immunogens against the tuberculosis infection. The signal sequence of antigen 85B and the whole HSP65 DNA sequence of human Mycobacterium tuberculosis (M. tuberculosis) were amplified from BCG genome and plasmid pCMV-MTHSP65 respectively by polymerase chain reactions (PCR). These two sequences were cloned into the plasmid pBCG-2100 under the control of the promoter of heat shock protein 70 (HSP70) from human M. tuberculosis, yielding the prokaryotic shuttle expression plasmid pBCG-SP-HSP65. Results of restriction endonuclease analysis, PCR detection and DNA sequencing analysis showed that the two cloned DNA sequences were consistent with those previously reported, and the direction of their inserting into the recombinant was correct and the reading frame had been maintained. The recombinants were electroporated into BCG to construct the recombinant BCG vaccine and induced by heating. The induced expression detected by SDS-PAGE showed that the content of 65 kD protein expressed in recombinant BCG was 35.69 % in total bacterial protein and 74.09 % in the cell lysate supernatants, suggesting that the recombinant HSP65 gene could express in BCG with high efficiency and the expressed proteins were mainly soluble. Western-blot showed that the secretive recombinant proteins could specifically combine with antibody against M. tuberculosis HSP65, indicating that the recombinant proteins possess the biological activity of HSP65.

Role of cytokines and other factors involved in the Mycobacterium tuberculosis infection

Mycobacterium tuberculosis （Mtb） is a pathogen that is widely distributed geographically and continues to be a major threat to world health. Bacterial virulence factors, nutritional state, host genetic condition and immune response play an important role in the evolution of the infection. The genetically diverse Mtb strains from different lineages have been shown to induce variable immune system response. The modern and ancient lineages strains induce different cytokines patterns. The immunity to Mtb depends on Th1-cell activity [interferon- γ （IFN- γ ）, interleukin-12 （IL-12） and tumor necrosis factor-α （TNF-α）]. IL-1β directly kills Mtb in murine and human macrophages. IL-6 is a requirement in host resistance to Mtb infection. IFN- γ , TNF-α, IL-12 and IL-17 are participants in Mycobacterium-induced granuloma formation. Other regulating proteins as IL-27 and IL-10 can prevent extensive immunopathology. CXCL 8 enhances the capacity of the neutrophil to kill Mtb . CXCL13 and CCL19 have been identified as participants in the formation of granuloma and control the Mtb infection. Treg cells are increased in patients with active tuberculosis （TB） but decrease with anti-TB treatment. The increment of these cells causes down- regulation of adaptive immune response facilitating the persistence of the bacterial infection. Predominance of Th2 phenotype cytokines increases the severity of TB. The evolution of the Mtb infection will depend of the cytokines network and of the infuence of other factors aforementioned.

Association between microsatellite markers and bovine tuberculosis in Chadian Zebu cattle

Bovine tuberculosis (BTB) is a considerable threat to livestock keepers and public health in many developing and underdeveloped countries. We investigated associations between 20 microsatellite markers and three phenotypes for BTB in a sample of the Chadian cattle population. The phenotypes measured were: 1) single intra-dermal comparative cervical tuberculin test (SICCT) performed on live animals, 2) presence of lesion post-slaughter, 3) a bacteriological tissue culture test for Mycobacterium bovis using the samples with observed lesions and 4) a predicted Bayesian model (BM) estimate of a true BTB disease status using all tested animals. All traits were recorded in binary form and as either 1 = presence or 0 = absence. A total of 224 animals for SICCT, lesion and BM traits and 96 animals with bacteriological culture test were genotyped. Generalised linear models were fitted to the binary BTB phenotypes that consisted of age (covariate), sex (2 levels), breed (2 levels) and markers (alleles: 5 - 14 levels) as explanatory variables and implemented in R using glm with a logit link function. The model was fitted for each marker, separately. Six out of 20 markers tested were significantly associated with at least one trait considered;these were ILSTS005, ILSTS006, TGLA227, BM2113 and CSRM66. Genomic regions around these markers may serve as a basis for further functional investigations. This is the first study to report association of microsatellite markers with bovine tuberculosis traits in African or Chadian cattle population.

Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

NAT2 Involed in the Susceptibility to Antituberculosis Drug-Induced Liver Injury

Objective: To investigate whether the N-acetyltransferase 2 (NAT2) gene is involved in the development of susceptibility to antituberculosis drug-induced liver damage (ATDLI) in patients with pulmonary tuberculosis in the Han nationality. Methods: We retrospectively analyzed 300 cases of tuberculosis patients without liver damage (control group) and 221 cases of tuberculosis patients with liver damage after antituberculosis treatment (case group). After antituberculosis treatment, genetic polymorphisms of NAT2 were analyzed in those patients using MassARRAY method. Results: Of the 10 tagged SNPs selected, In the promoter area of NAT2, the frequencies of T allele in rs4646243 and A allele in rs4646246 were significantly higher in the patients with ATDLI than controls (0.569 vs. 0.483, p=0.0062 and 0.567 vs 0.487, p=0.0103). The A allele of rs1115784 in the intron area showed a significant association with the development of ATDLI (0.389 vs 0.305, p = 0.0043). The frequencies of the mutated genes T and A in rs1041983 and rs1799930 in the second exon region were significantly higher than those in the control group (0.491 vs 0.360, p<0.00001 and 0.336 vs 0.212, respectively;p<0.00001). Two monomer domains were found in the 10 tag SNP sites, haplotype ht [TGAA] in monomeric domain 1 and haplotype ht [TAG] in monomeric domain 2, both were significantly more likely to be detected in the liver injury group than in the control group(p=0.0038, p<0.001, respectively). Two haplotypes were also found on the NAT2 gene: haplotype ht [CGGG] in monomeric domain 1 and ht [CGG] in block 2, and their presence means a lower risk of liver damage. Conclusion: NAT2 genotypes might have significant association with the risk of ATDLI in the Chinese Han nationality. By detecting the NAT2 gene and its haplotype, we can screen patients with a higher risk of liver damage before anti-TB treatment and take measures for the protection of patients.

Relationship between CYP2E1 Gene Polymorphism and Anti-tuberculosis Drug-induced Liver Injury

Objective: To investigate the relationship between cytochrome P450 E1 (CYP2E1) gene polymorphisms and susceptibility to anti-tuberculosis drug-induced liver damage (ATDLI) in tuberculosis patients in the Chinese Han nationality. Methods: A retrospective analysis was performed on 360 patients with tuberculosis who had liver damage after tuberculosis treatment (case group) and 360 patients with tuberculosis who did not develop liver injury after treatment (control group). MassARRAY were used to detect CYP2E1 gene polymorphisms. Results: In a total of 8 tagged SNP loci selected, the rs8192773 locus failed to pass the test, and therefore, it is not included in subsequent analysis. At the remaining seven SNP sites, the difference in alleles was not statistically significant between the case group and the control group, suggesting that these sites may not be related to liver damage caused by anti-tuberculosis drugs. Three monomer domains were found in the seven tags SNP loci mentioned above. However, it was found that these haplotypes are not closely related to anti-tuberculosis drug-induced liver damage. Conclusion: The CYP2E1 gene polymorphism in the Chinese Han nationality is not related to the occurrence of anti-tuberculosis drug-induced liver injury.

Differences in the population of genetics of Mycobacterium tuberculosis between urban migrants and local residents in Beijing, China

Background Currently, migration has become one of the risk factors of high burden of tuberculosis in China. This study was to explore the influence of mass migration on the dynamics of Mycobacterium （M.） tuberculosis in Beijing, the capital and an urban area of China.

Advances in the development of molecular genetic tools for Mycobacterium tuberculosis

Mycobacterium tuberculosis, a Gram-positive bacterium of great clinical relevance, is a lethal pathogen owing to its complex physiological characteristics and development of drug resistance. Several molecular genetic tools have been developed in the past few decades to study this microorganism. These tools have been instrumental in understanding how M. tuberculosis became a successful pathogen. Advanced molecular genetic tools have played a significant role in exploring the complex pathways involved in M. tuberculosis pathogenesis. Here, we review various molecular genetic tools used in the study of M. tuberculosis. Further, we discuss the applications of clustered regularly interspaced short palindromic repeat interference（CRISPRi）, a novel technology recently applied in M. tuberculosis research to study target gene functions. Finally, prospective outcomes of the applications of molecular techniques in the field of M. tuberculosis genetic research are also discussed.

Effects of different cytokines on proliferation and apoptosis of pleural mesothelial cells in human Mycobacterium tuberculosis infection

Objective To investigate the effects of different cytokines (IL-22,IL-17,IFN-γ) on proliferation and apoptosis of human pleural mesothelial cells (PMC) during Mycobacterium tuberculosis infection.Methods

Comparison of interferon-gamma release assays and adenosine deaminase of pleural fluid for the diagnosis of pleural tuberculosis

Objective To compare the diagnostic performance of interferon gamma releasing assays(T-SPOT.TB)and adenosine deaminase(ADA)in pleural tuberculosis,and therefore to evaluate the value of T-SPOT.TB in a high tuberculosis burden country.Methods From June 2011to November 2012,111 patients with pleural fluid in Beijing Chest Hospital,Capital Medical University

Immune responses and immigration of Mycobacterium tuberculosis-specific T lymphocytes in patients with tuberculous pleuritis

Objective To compare the immune responses of Mycobacterium tuberculosis(M.tb)-specific T lymphocy between the peripheral blood and pleural effusion in patients with tuberculous pleurisy.Methods Twelve initially treated cases of tuberculous pleurisy who were hospitalized in Wuxi No.5 People’s Hospital from Oct 2012 to Apr

CT imaging of coexisting pulmonary tuberculosis and lung cancer

Objective To study the CT characteristics of coexisting pulmonary tuberculosis and lung cancer. Methods One hundred and four patients of coexisting pulmonary tuberculosis and lung cancer proved by histology,cytology or clinical underwent CT examination. All patients were divided into two groups。

Pleural effusion: presentation, causes and treatment outcome in a resource limited area, Ethiopia

Back ground: Pleural effusion is a common clinical problem with different causes. Objective: To demonstrate clinical features and outcome of pleural effusion. Methods: Prospective descriptive study was conducted involving 110 patients with pleural effusion admitted to a resource limited hospital in Ethiopia. Results: Males and females were almost equally represented. Cough, fever and weight loss were prominent presenting symptoms accounting 90, 77.3 and 77.3 percent respectively. Right side effusion was the common presentation 50 (45.5%). Forty (37.4%) patients had HIV infection among 107 tested. Tuberculosis was the commonest cause 78 (70.9%) followed by parapneumonic effusion 36 (32.7%) and empyema 27 (24.5%). Malignant pleural effusion was detected only in one patient. Eighty one (73.6%) improved from their illness and 7 (6.4%) died. Lympocytic pleural effusion found to be associated with tuberculosis (OR = 3.942 (1.527 - 10.179), P = 0.005. There were no associations between HIV infection, anemia, elevated ESR and side of pleural effusion with tuberculosis. Conclusion: Tuberculosis was the leading cause of pleural effusion in our setup even though etiologic diagnosis was difficult. Strengthening the laboratory and pathology services in the area is strongly recommended.

结核性胸膜炎发生脓胸的临床分析

目的分析结核性胸膜炎发生、发展为结核性脓胸的因素。方法分析2016年6月至2020年6月太原市第四人民医院收治的32例结核性脓胸患者资料,分析患者临床表现、影像学特征、演变及治疗转归。结果32例患者年龄22~68岁,平均(36±7)岁。其中29例结核性胸膜炎患者为不规律用药,不及时引流胸腔积液,病程迁延7个月至5年,病变部位左侧占18例,右侧占12例。有耐药结核存在者3例。3例患者年龄≥65岁,病程≥3年,合并慢性糖尿病,血清白蛋白≤40 g/L,体质量指数(BMI)≤18.5 kg/m^(2)。结论结核性胸膜炎患者应及早进行规律全程抗结核治疗,短期内控制感染,尽早引流胸腔积液,避免病情迁延发生结核性脓胸。

云南省昭通地区结核分枝杆菌临床分离株遗传多样性和耐药分子特征

目的调查云南省昭通地区结核分枝杆菌(Mycobacterium tuberculosis,MTB)临床分离株的遗传多样性和耐药分子特征。方法2022年9月—2023年8月从昆明医科大学附属昭通医院收治的298例涂阳肺结核患者中共采集了MTB 298株,用MeltPro TB测定法通过荧光聚合酶链反应(polymerase chain reaction,PCR)熔解曲线法鉴定所有分离株。用多色熔解曲线分析技术进行间隔区寡核苷酸分型(interval oligonucleotide typing,Spoligotyping)。用分枝杆菌散布重复单元(mycobcterial interspersed repetitive units,MIRU)-可变数目串联重复序列分型(variable number of tandem repeat typing,VNTR)(MIRU-VNTR)24位点分型法进行基因分型。使用PCR和靶向测序检测耐药基因突变。结果北京菌株占所有MTB菌株的69.80%(208/298)。其他谱系包括T、LAM、MANU2、CAS、NEW-1和SITVITWEB数据库中未发现的孤儿型,分别占5.70%(17/298)、3.36%(10/298)、0.67%(2/298)、0.34%(1/298)、8.39%(25/298)及11.74%(35/298)。北京菌株对左氧氟沙星的耐药率略高于非北京菌株(P=0.042),而北京菌株与非北京菌株2种基因型菌株对异烟肼、利福平、乙胺丁醇、链霉素、吡嗪酰胺、卡那霉素耐药率差异无统计学意义(P>0.05)。MIRU-VNTR 24位点分型分析结果显示,33个菌株可分为13株聚类,其聚类率为39.39%。每个等位基因的Hunter-Gaston指数在0~0.814之间,其中18个位点对非北京菌株具有中高鉴别能力。但只有10个位点对北京菌株具有中高鉴别能力。结论MTB菌株在中国云南省昭通地区表现出较高的遗传多样性,北京菌株是MTB和耐药结核病菌株的优势谱系。

液态芯片技术筛选胸腔积液细胞因子对结核性胸膜炎的诊断价值

目的应用液态芯片技术筛选结核性胸膜炎(plTB)胸腔积液结核特异性细胞因子建立诊断模型,并探讨其应用价值。方法纳入plTB患者(plTB组)86例,其中确诊plTB组41例,临床诊断plTB组45例;其他胸腔积液患者(对照组)42例。采用液相芯片技术分析胸腔积液17个细胞因子,包括白细胞介素(IL)-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-9、IL-10、γ-干扰素诱导蛋白10(IP-10)、IL-15、IL-17F、IL-27、肿瘤坏死因子(TNF)-α、单核细胞趋化蛋白-1(MCP-1)、巨噬细胞炎症蛋白-3a(MIP-3α)、巨噬细胞集落刺激因子(M-CSF)、β-干扰素(IFN-β)的表达量。筛选确诊plTB组和对照组组间差异因子,并在确诊plTB患者中绘制受试者工作特征(ROC)曲线,将AUC>0.850、特异度>80%的IP-10、IL-27和MCP-1联合诊断plTB,并同胸腔积液腺苷酸脱氨酶(ADA)检测和结核感染T细胞斑点试验(T-SPOT.TB)比较,评估诊断效能。结果确诊plTB组IL-2、IP-10、IL-27、TNF-α和MCP-1水平均高于对照组(P<0.05);IP-10、IL-27和MCP-1三因子联合确诊plTB的敏感度为87.8%,特异度为81.0%;三因子联合诊断在45例临床诊断plTB组中的敏感度仍高达86.7%,与确诊plTB组的敏感度比较,差异无统计学意义(P>0.05)。plTB组中,TIP-10、IL-27和MCP-1三因子联合检测的敏感度为87.2%,高于T-SPOT.TB单独检测(81.4%)和ADA单独检测(54.7%)。结论应用液态芯片技术对胸腔积液IP-10、IL-27和MCP-1联合检测,可为plTB诊断提供帮助。

结核感染T细胞斑点试验、结核分枝杆菌核酸恒温扩增检测及腺苷脱氨酶联合检测在结核性胸腔积液诊断中的价值

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)、结核分枝杆菌核酸恒温扩增检测(TB-SAT)、腺苷脱氨酶(ADA)联合检测对结核性胸腔积液的诊断价值。方法选择2021年1月至2021年12月于新乡医学院第一附属医院就诊的135例胸腔积液患者为研究对象,其中结核性胸腔积液患者83例,非结核性胸腔积液患者52例。135例患者均进行外周血T-SPOT.TB、胸腔积液TB-SAT和胸腔积液ADA检测,比较3种方法单独检测和联合检测诊断结核性胸腔积液的灵敏度及特异度。结果T-SPOT.TB、TB-SAT、ADA单独检测诊断结核性胸腔积液的灵敏度、特异度比较差异均无统计学意义(P>0.05)。T-SPOT.TB+TB-SAT联合检测诊断结核性胸腔积液的灵敏度显著高于T-SPOT.TB、TB-SAT、ADA单独检测(χ^(2)=4.990、13.410、14.590,P<0.05);T-SPOT.TB+TB-SAT联合检测诊断结核性胸腔积液的特异度与T-SPOT.TB、TB-SAT、ADA单独检测比较差异均无统计学意义(χ^(2)=0.000、2.420、0.060,P>0.05)。T-SPOT.TB+ADA联合检测诊断结核性胸腔积液的灵敏度显著高于ADA单独检测(χ^(2)=4.069,P<0.05),与T-SPOT.TB、TB-SAT单独检测比较差异无统计学意义(χ^(2)=0.055、3.384,P>0.05)。T-SPOT.TB+ADA联合检测诊断结核性胸腔积液的特异度显著低于T-SPOT.TB、TB-SAT、ADA单独检测(χ^(2)=4.370、12.511、5.371,P<0.05)。TB-SAT+ADA联合检测诊断结核性胸腔积液的灵敏度与T-SPOT.TB、TB-SAT、ADA单独检测比较差异均无统计学意义(χ^(2)=0.000、2.604、3.213,P>0.05)。TB-SAT+ADA联合检测诊断结核性胸腔积液的特异度显著低于TB-SAT单独检测(χ^(2)=5.765,P<0.05),与T-SPOT.TB、ADA单独检测比较差异均无统计学意义(χ^(2)=0.782、1.251,P>0.05)。T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的灵敏度显著高于T-SPOT.TB、TB-SAT、ADA单独检测(χ^(2)=6.760、15.755、16.966,P<0.05);T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的特异度显著低于T-SPOT.TB、TB-SAT、ADA单独检测(χ^(2)=4.370、12.511、5.371,P<0.05)。T-SPOT.TB+TB-SAT联合检测诊断结核性胸腔积液的灵敏度显著高于T-SPOT.TB+ADA、TB-SAT+ADA联合检测(χ^(2)=4.090、4.990,P<0.05);T-SPOT.TB+ADA联合检测与TB-SAT+ADA联合检测诊断结核性胸腔积液的灵敏度比较差异无统计学意义(χ^(2)=0.060,P>0.05)。T-SPOT.TB+TB-SAT联合检测诊断结核性胸腔积液的特异度显著高于T-SPOT.TB+ADA联合检测(χ^(2)=4.371,P<0.05);TB-SAT+ADA联合检测诊断结核性胸腔积液的特异度与T-SPOT.TB+TB-SAT、T-SPOT.TB+ADA联合检测比较差异无统计学意义(χ^(2)=0.780、1.490,P>0.05)。T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的灵敏度与T-SPOT.TB+TB-SAT联合检测比较差异无统计学意义(χ^(2)=0.210,P>0.05);T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的灵敏度显著高于T-SPOT.TB+ADA、TB-SAT+ADA联合检测(χ^(2)=5.750、6.760,P<0.05)。T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的特异度显著低于T-SPOT.TB+TB-SAT联合检测(χ^(2)=4.370,P<0.05);T-SPOT.TB+TB-SAT+ADA三者联合检测诊断结核性胸腔积液的特异度与T-SPOT.TB+ADA、TB-SAT+ADA联合检测比较差异无统计学意义(χ^(2)=0.000、1.490,P>0.05)。结论联合检测较单一检测诊断结核性胸腔积液效果理想,外周血T-SPOT.TB联合胸腔积液TB-SAT诊断结核性胸腔积液的总体效能最好。联合检测能有效降低漏诊率和误诊率,对结核性胸腔积液具有较高的临床应用价值。