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Abstract：
BACKGROUND: Pleural fluid is one of the common complications of thoracic diseases, and tuberculous pleural effusion (TPE) is the most common cause of pleural effusion in TB-endemic areas and the most common type of exudative pleural effusion in China. In clinical practice, distinguishing TPE from pleural effusion caused by other reasons remains a relatively challenging issue. The objective of present study was to explore the clinical significance of the pleural fluid lactate dehydrogenase/adenosine deaminase ratio (pfLDH/pfADA) in the diagnosis of TPE.
METHODS: The clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE.
RESULTS: The median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA.
CONCLUSIONS: Compared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically.
METHODS: The clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE.
RESULTS: The median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA.
CONCLUSIONS: Compared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically.
摘要：
背景：胸水是胸部疾病的常见并发症之一，结核性胸腔积液（TPE）是结核病流行地区胸腔积液的最常见原因，也是中国最常见的渗出性胸腔积液类型。在临床实践中,区分TPE和其他原因引起的胸腔积液仍然是一个相对具有挑战性的问题.目的探讨胸水乳酸脱氢酶/腺苷脱氨酶比值(pfLDH/pfADA)在TPE诊断中的临床意义。
方法:回顾性收集618例胸腔积液患者的临床资料,将患者分为3组：TPE组（412例），肺炎旁胸腔积液（PPE）组（106例），恶性胸腔积液(MPE)组100例。比较3组间胸腔积液相关指标和血清学相关指标比值的差异,绘制受试者工作特征曲线,分析不同指标参数比值对TPE诊断的敏感性和特异性。
结果：TPE组的血清ADA水平中位数（13U/L）高于PPE组（10U/L，P<0.01)和MPE组(10U/L,P<0.001)。TPE组pfADA中位数为41（32，52）U/L；MPE组最低，为9（7，12）U/L，PPE组最高，为43（23，145）U/L。PPE组pfLDH水平为2542(1109,6219)U/L,明显高于TPE组449(293，664)U/L。在TPE和非TPE的鉴别诊断中，pfLDH/pfADA诊断TPE的AUC最高为0.946(0.925,0.966),最佳临界值为23.20，灵敏度为93.9%，特异性为87.0%，尤登指数为0.809。在TPE和PPE的鉴别诊断中，pfLDH/pfADA的AUC最高为0.964(0.939,0.989),最佳截止值为24.32，灵敏度为94.6%，特异性为94.4%；这表明诊断效能明显优于pfLDH单一指标。在TPE和MPE的鉴别诊断中,pfLDH/pfADA的AUC为0.926(0.896,0.956),敏感性为93.4%，特异性为80.0%；这与pfADA的诊断效能无显著差异。
结论：与单一生物标志物相比，pfLDH/pfADA对TPE有较高的诊断价值,能早期识别TPE患者,容易,和经济上。
方法:回顾性收集618例胸腔积液患者的临床资料,将患者分为3组：TPE组（412例），肺炎旁胸腔积液（PPE）组（106例），恶性胸腔积液(MPE)组100例。比较3组间胸腔积液相关指标和血清学相关指标比值的差异,绘制受试者工作特征曲线,分析不同指标参数比值对TPE诊断的敏感性和特异性。
结果：TPE组的血清ADA水平中位数（13U/L）高于PPE组（10U/L，P<0.01)和MPE组(10U/L,P<0.001)。TPE组pfADA中位数为41（32，52）U/L；MPE组最低，为9（7，12）U/L，PPE组最高，为43（23，145）U/L。PPE组pfLDH水平为2542(1109,6219)U/L,明显高于TPE组449(293，664)U/L。在TPE和非TPE的鉴别诊断中，pfLDH/pfADA诊断TPE的AUC最高为0.946(0.925,0.966),最佳临界值为23.20，灵敏度为93.9%，特异性为87.0%，尤登指数为0.809。在TPE和PPE的鉴别诊断中，pfLDH/pfADA的AUC最高为0.964(0.939,0.989),最佳截止值为24.32，灵敏度为94.6%，特异性为94.4%；这表明诊断效能明显优于pfLDH单一指标。在TPE和MPE的鉴别诊断中,pfLDH/pfADA的AUC为0.926(0.896,0.956),敏感性为93.4%，特异性为80.0%；这与pfADA的诊断效能无显著差异。
结论：与单一生物标志物相比，pfLDH/pfADA对TPE有较高的诊断价值,能早期识别TPE患者,容易,和经济上。
