Diagnositic efficacy of clinical characteristics and laboratory indexes in tuberculous pleural effusion and malignant pleural effusion_West China Medical Journal

Authors：

HUANG Yanchun , WU Lijuan , DING Liu , LU Xiaojun , LIU Tangyuheng ,  YING Binwu

Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YING Binwu, Email: binwuying@126.com

Keywords：

Tuberculous pleural effusion; Malignant pleural effusion; Laboratory indexes; Diagnostic efficacy

DOI：

10.7507/1002-0179.201807065

Video：

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ObjectiveTo analyze the clinical characteristics of patients with tuberculous pleural effusion and malignant pleural effusion and explore the value of laboratory indexes of pleural effusion in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion.MethodsThe clinical data and laboratory indexes of pleural effusion of patients with tuberculous pleural effusion and patients with malignant pleural effusion hospitalized in West China Hospital of Sichuan University between January and December 2017 were analyzed retrospectively. Those examinations with statistical significance were selected to establish a binary logistic regression model for diagnosing malignant pleural effusion from tuberculous pleural effusion. Hosmer-Lemeshow test was used to assess the goodness of fit of the logistic model, and a receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of the model.ResultsThe average age of the 128 patients with tuberculous pleural effusion was (51.60±21.02) years, and the average age of the 164 malignant pleural effusion was (63.52±11.87) years. Patients with tuberculous pleural effusion were prone to getting symptoms of cough, expectoration, fever, chest pain and tightness in breathing, with statistical significance (P<0.05). The level of adenosine deaminase in patients with tuberculous pleural effusion was (23.06±21.29) U/L, higher than that in malignant pleural effusion; the difference was statistically significant (P<0.05). The levels of albumin, glucose, carbohydrate antigen (CA) 125, CA19-9, carcinoembryonic antigen (CEA) and cyto-keratin 19 fragment antigen 21-1 in patients with malignant pleural effusion were higher than those in patients with tuberculous pleural effusion (P<0.05). Logistic regression analysis showed that CA125, CEA and glucose were introduced to model as the main effect. The area under the ROC curve was 0.914 [95% confidence interval (0.864, 0.964)], with an improved diagnostic efficiency.ConclusionsThe clinical manifestations of tuberculous pleural effusion and malignant pleural effusion are multifarious with low specificity. A joint detection of CA125, CEA and glucose in pleural effusion and the joint diagnostic model can identify tuberculous pleural effusion and malignant pleural effusion better.

Citation： HUANG Yanchun, WU Lijuan, DING Liu, LU Xiaojun, LIU Tangyuheng, YING Binwu. Diagnositic efficacy of clinical characteristics and laboratory indexes in tuberculous pleural effusion and malignant pleural effusion. West China Medical Journal, 2018, 33(8): 966-971. doi: 10.7507/1002-0179.201807065 Copy

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11.	杜玲. 多指標聯合檢測對結核性胸腔積液的診斷效能研究. 國際檢驗醫學雜志, 2017, 38(12): 1715-1717.
12.	張立群, 王云霞, 張軒, 等. 肺癌相關腫瘤標志物在肺部疾病患者血清中表達的對比分析. 中華醫院感染學雜志, 2012, 22(20): 4478-4480.
13.	梁偉權, 胡佩村. 結核性胸膜炎患者治療前后血清糖類抗原 125 水平的變化及臨床意義. 國際呼吸雜志, 2015, 35(14): 1075-1077.
14.	張倩云. 胸水腺苷脫氨酶乳酸脫氫酶癌胚抗原對結核性胸膜炎和癌性胸腔積液的鑒別診斷價值探討. 河北醫學, 2015, 21(4): 576-578.
15.	夏靜, 閆雪波, 劉榮玉. 聯合檢測 CEA、ADA、LDH 及血沉對胸腔積液性質判斷的臨床意義. 安徽醫藥, 2013, 17(2): 222-224.
16.	Samanta S, Sharma A, Das B, et al. Significance of total protein, albumin, globulin, serum effusion albumin gradient and LDH in the differential diagnosis of pleural effusion secondary to tuberculosis and cancer. J Clin Diagn Res, 2016, 10(8): BC14-BC18.
17.	李多孚, 陳郁琳, 夏雨. 胸水 ADA、LDH 診斷結核性胸膜炎的臨床效能評價. 檢驗醫學, 2015, 30(10): 987-990.

1. World Health Organization. Global Tuberculosis report 2017. Geneva: World Health Organization, 2017. http://www.who.int/tb/publications/global_report/en/.
2. Light RW. Update on tuberculous pleural effusion. Respirology, 2010, 15(3): 451-458.
3. 中華人民共和國國家衛生和計劃生育委員會. 肺結核診斷: WS 288-2017, 2017.
4. 施煥中. 惡性胸腔積液診斷與治療專家共識. 中華內科雜志, 2014, 53(3): 252-256.
5. Villena V, López Encuentra A, Echave-Sustaeta J, et al. Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients. Arch Bronconeumol, 2002, 38(1): 21-26.
6. 全國第五次結核病流行病學抽樣調查技術指導組, 全國第五次結核病流行病學抽樣調查辦公室. 2010 年全國第五次結核病流行病學抽樣調查報告. 中國防癆雜志, 2012, 34(8): 485-508.
7. 趙志剛, 邱添, 梁志欣. 22 例肺炎型肺癌臨床分析. 山東醫藥, 2016, 56(11): 77-78.
8. Liam CK, Lim KH, Wong CM. Tuberculous pleurisy as a manifestation of primary and reactivation disease in a region with a high prevalence of tuberculosis. Int J Tuberc Lung Dis, 1999, 3(9): 816-822.
9. 盧旭東, 周興菊, 陸益民. 肺癌患者胸水 CD40、MMP-12 水平的檢測和臨床意義. 臨床肺科雜志, 2015, 20(7): 1174-1176.
10. 黃小偉, 王飛, 聶森, 等. 結核性滲出性胸膜炎及惡性胸腔積液患者 CEA、ADA 聯合檢測及 RO C 分析. 安徽醫藥, 2014, 18(8): 1475-1477.
11. 杜玲. 多指標聯合檢測對結核性胸腔積液的診斷效能研究. 國際檢驗醫學雜志, 2017, 38(12): 1715-1717.
12. 張立群, 王云霞, 張軒, 等. 肺癌相關腫瘤標志物在肺部疾病患者血清中表達的對比分析. 中華醫院感染學雜志, 2012, 22(20): 4478-4480.
13. 梁偉權, 胡佩村. 結核性胸膜炎患者治療前后血清糖類抗原 125 水平的變化及臨床意義. 國際呼吸雜志, 2015, 35(14): 1075-1077.
14. 張倩云. 胸水腺苷脫氨酶乳酸脫氫酶癌胚抗原對結核性胸膜炎和癌性胸腔積液的鑒別診斷價值探討. 河北醫學, 2015, 21(4): 576-578.
15. 夏靜, 閆雪波, 劉榮玉. 聯合檢測 CEA、ADA、LDH 及血沉對胸腔積液性質判斷的臨床意義. 安徽醫藥, 2013, 17(2): 222-224.
16. Samanta S, Sharma A, Das B, et al. Significance of total protein, albumin, globulin, serum effusion albumin gradient and LDH in the differential diagnosis of pleural effusion secondary to tuberculosis and cancer. J Clin Diagn Res, 2016, 10(8): BC14-BC18.
17. 李多孚, 陳郁琳, 夏雨. 胸水 ADA、LDH 診斷結核性胸膜炎的臨床效能評價. 檢驗醫學, 2015, 30(10): 987-990.

West China Medical Journal

Diagnositic efficacy of clinical characteristics and laboratory indexes in tuberculous pleural effusion and malignant pleural effusion

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