Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion
Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion
复制标题
胸腔IFN-γ释放试验结合生物标志物有效区分结核病和恶性胸腔积液
DOI：
10.1186/s12879-018-3654-z
复制
发表时间：
2019-01-16
影响因子：
3.7
通讯作者：
Zhang, Guoliang
中科院分区：
文献类型：
--
作者：
Tang, Yimin;Zhang, Juanjuan;Zhang, Guoliang
背景结核病（TB）仍然是全球范围内的主要公共卫生问题，特别是在发展中国家。到目前为止，结核性胸膜炎的诊断和治疗还没有正式的指南。结核性胸腔积液（TPE）和恶性胸腔积液（MPE）的鉴别测定非常困难，这使得结核病的诊断更加恶化。本研究的目的是评估胸膜IFN-释放试验（IGRA）和广泛使用的生化参数在TPE和MPE的区别分析的鉴别诊断效率。MethodsA队列的222例胸腔积液患者进行了检查，包括143 TPE和58 MPE患者。采用免疫组化法（IGRA）检测患者胸腔积液和外周血中广泛使用的生物标志物。与MPE患者相比，结核病（Mtb）抗原特异性IFN-γ对血液中ESAT-6蛋白和肽池的反应。TPE患者还显示在胸腔积液中比在外周血中具有富集的Mtb抗原特异性IFN-应答。在广泛应用的生物标志物中，胸水中的腺苷脱氨酶（ADA）和癌胚抗原（CEA）是鉴别TPE和MPE的较好的生物标志物，具有较高的敏感性和特异性。此外，胸膜IGRA不受胸膜粘连的影响，联合检测胸膜IGRA和ADA、CEA为TPE和MPE的鉴别诊断提供了一种新的方法。结论：胸膜IGRA与ADA、CEA联合检测可为TPE和MPE的鉴别诊断提供更有效的诊断策略。
BackgroundTuberculosis (TB) remains a major public health concern on a global scale, especially in developing nations. So far, no formal guidelines are available for the diagnosis and treatment of tuberculosis pleurisy. The diagnosis of TB is worsened by the immense difficulty in differential determination of tuberculosis pleural effusion (TPE) and malignant pleural effusion (MPE). The purpose of this investigation is to assess the differential diagnostic efficiencies of the pleural IFN- release assay (IGRA) and widely-used biochemical parameters in the distinction analysis of TPE and MPE.MethodsA cohort of 222 patients with pleural effusion was examined, comprising of 143 TPE and 58 MPE patients. The patients were examined with IGRA, and the widely-used biomarkers in the pleural effusion and peripheral blood.ResultsOur results show that the TPE patients have significantly higher M. tuberculosis (Mtb) antigen-specific IFN- responses to ESAT-6 protein and peptide pool in the blood compared to MPE patients. TPE patients were also shown to have enriched Mtb antigen-specific IFN- responses in pleural effusion than in peripheral blood. Among the widely-used biomarkers, the adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in pleural effusion were better biomarkers with high sensitivity and specificity to discriminate TPE and MPE. In addition, pleural IGRA could not be affected by the pleural adhesion, and the applications of the pleural IGRA together with ADA and CEA provide a promising approach for the TPE and MPE differential identification.ConclusionsOur study proposes that the integration of pleural IGRA and ADA, CEA detection could add to more effective diagnosis stratagems in the discernment between TPE and MPE.