Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy
Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy
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DOI：
10.1007/5584_2014_105
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发表时间：
2015-01-01
期刊：
影响因子：
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通讯作者：
Chazan, R.
中科院分区：
文献类型：
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作者：
Klimiuk, J.;Krenke, R.;Chazan, R.
由于结核性胸腔积液的少细菌性质，胸膜结核的诊断是具有挑战性的。本前瞻性研究旨在评估十种不同胸腔液体生物标志物在鉴别结核性和非结核性胸腔积液中的诊断性能。203例胸腔积液患者（男性117例，女性86例，中位年龄65岁）被纳入研究。常规诊断检查，包括胸腔穿刺和胸腔积液分析，以确定胸腔积液的原因。测定胸膜液中下列生物标志物：腺苷脱氨酶（ADA）、干扰素γ (IFN-gamma)、白细胞介素2可溶性受体（IL-2sR α）、白细胞介素12b亚基p40 （IL-12p40）、白细胞介素18 （IL-18）、白细胞介素23 （IL-23）、白细胞介素γ诱导蛋白10kda （IP-10）、fas配体、人巨噬细胞衍生趋化因子（MDC）和肿瘤坏死因子α (tnf - α)。结核性胸腔积液44例（21.7%），恶性胸腔积液88例（43.3%），肺旁积液/胸膜脓肿35例（17.2%），胸腔突出30例（14.8%），其他基础疾病6例（3%）。胸腔积液ifn - γ是鉴别结核性与非结核性胸腔积液最准确的指标，其敏感性、特异性、PPV、NPV和AUC分别为97%、98%、95.5%、99.4%和0.99。另外两个生物标志物（IP-10和Fas配体）也显示出非常高的诊断准确性，AUC >= 0.95。ADA的AUC为0.92。我们得出结论，胸膜液中的ifn - γ、IP-10和fas配体是鉴别结核性和非结核性胸膜液的高度准确的生物标志物。
Due to the paucibacillary nature of tuberculous pleural effusion the diagnosis of pleural tuberculosis is challenging. This prospective study was undertaken to evaluate the diagnostic performance of ten different pleural fluid biomarkers in the differentiation between tuberculous and non-tuberculous pleural effusions. Two hundred and three patients with pleural effusion (117 men and 86 women, median age 65 years) were enrolled. Routine diagnostic work-up, including thoracentesis and pleural fluid analysis, was performed to determine the cause of pleural effusion. The following biomarkers were measured in pleural fluid: adenosine deaminase (ADA), interferon gamma (IFN-gamma), interleukin 2 soluble receptor (IL-2sR alpha), subunit p40 of interleukin 12b (IL-12p40), interleukin 18 (IL-18), interleukin 23 (IL-23), IFN-gamma induced protein 10 kDa (IP-10), Fas-ligand, human macro-phage-derived chemokine (MDC) and tumor necrosis factor alfa (TNF-alpha). There were 44 (21.7 %) patients with tuberculous pleural effusion, 88 (43.3 %) patients with malignant pleural effusion, 35 (17.2 %) with parapneumonic effusion/pleural empyema, 30 (14.8 %) with pleural transudates, and 6 (3 %) with miscellaneous underlying diseases. Pleural fluid IFN-gamma was found the most accurate marker differentiating tuberculous from non-tuberculous pleural effusion, with sensitivity, specificity, PPV, NPV, and AUC 97 %, 98 %, 95.5 %, 99.4 %, and 0.99, respectively. Two other biomarkers (IP-10 and Fas ligand) also showed very high diagnostic accuracy with AUC >= 0.95. AUC for ADA was 0.92. We conclude that IFN-gamma, IP-10, and Fas-ligand in pleural fluid are highly accurate biomarkers differentiating tuberculous from non-tuberculous pleural effusion.