A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion
A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion
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QuantiFERON-TB Gold In-Tube 检测与腺苷脱氨酶检测相结合可提高结核性胸腔积液的诊断
DOI：
10.1038/emi.2016.80
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发表时间：
2016-08-03
影响因子：
13.2
通讯作者：
Zhang, Wenhong
中科院分区：
文献类型：
--
作者：
Liu, Yuanyuan;Ou, Qinfang;Zhang, Wenhong
尽管有许多诊断工具可用，但结核性胸腔积液(TPE)和恶性胸腔积液(MPE)的鉴别诊断仍然很困难。本研究旨在评价全血定量结核金试管试验(QFT-GIT)和常规实验室生物标志物在结核病高发区鉴别诊断TPE和MPE中的作用。共纳入117例胸腔积液患者，其中91例为TPE，26例为MPE。所有患者均进行QFT-GIT检测，并检测血液和胸腔积液中的常规生物标志物。TPE患者全血中抗原刺激的QFT-GIT水平显著高于MPE患者(2.89vs0.33 IU/mL，P<；0.0001)。QFT-GIT诊断TPE的敏感性为93.0%，特异性为60.0%。在血液和胸腔积液中，腺苷脱氨酶是最显著的标志物，其临界值为15.35 IU/L，诊断胸腔积液的敏感性为93.4%，特异性为96.2%。这两个生物标志物联合建立的诊断分类树的敏感度为97.8%，特异度为92.3%。最终，全血QFT-GIT和胸膜ADA的联合检测将特异度和阳性预测值均提高到100%。因此，QFT-GIT在鉴别诊断TPE和MPE方面并不优于胸膜ADA。全血QFT-GIT与胸膜ADA联合检测可提高TPE的诊断率。
The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remains difficult despite the availability of numerous diagnostic tools. The current study aimed to evaluate the performance of the whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and conventional laboratory biomarkers in differential diagnosis of TPE and MPE in high tuberculosis prevalence areas. A total of 117 patients with pleural effusions were recruited, including 91 with TPE and 26 with MPE. All of the patients were tested with QFT-GIT, and the conventional biomarkers in both blood and pleural effusion were detected. The level of antigen-stimulated QFT-GIT in the whole blood of TPE patients was significantly higher than that of MPE (2.89 vs 0.33 IU/mL,P<0.0001). The sensitivity and specificity of QFT-GIT for the diagnosis of TPE were 93.0% and 60.0%, respectively. Among the biomarkers in blood and pleural effusion, pleural adenosine deaminase (ADA) was the most prominent biomarker, with a cutoff value of 15.35 IU/L. The sensitivity and specificity for the diagnosis of TPE were 93.4% and 96.2%, respectively. The diagnostic classification tree from the combination of these two biomarkers was 97.8% sensitive and 92.3% specific. Ultimately, the combination of whole blood QFT-GIT with pleural ADA improved both the specificity and positive predictive value to 100%. Thus, QFT-GIT is not superior to pleural ADA in the differential diagnosis of TPE and MPE. Combined whole blood QFT-GIT and pleural ADA detection can improve the diagnosis of TPE.