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. 多指标联合检测对结核性胸腔积液的诊断效能研究. 国际检验医学杂志, 2017, 38(12): 1715-1717.
12.	张立群, 王云霞, 张轩, 等. 肺癌相关肿瘤标志物在肺部疾病患者血清中表达的对比分析. 中华医院感染学杂志, 2012, 22(20): 4478-4480.
13.	梁伟权, 胡佩村. 结核性胸膜炎患者治疗前后血清糖类抗原 125 水平的变化及临床意义. 国际呼吸杂志, 2015, 35(14): 1075-1077.
14.	张倩云. 胸水腺苷脱氨酶乳酸脱氢酶癌胚抗原对结核性胸膜炎和癌性胸腔积液的鉴别诊断价值探讨. 河北医学, 2015, 21(4): 576-578.
15.	夏静, 闫雪波, 刘荣玉. 联合检测 CEA、ADA、LDH 及血沉对胸腔积液性质判断的临床意义. 安徽医药, 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, 陈郁琳, 夏雨. 胸水 ADA、LDH 诊断结核性胸膜炎的临床效能评价. 检验医学, 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. 中华人民共和国国家卫生和计划生育委员会. 肺结核诊断: WS 288-2017, 2017.
4. 施焕中. 恶性胸腔积液诊断与治疗专家共识. 中华内科杂志, 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. 全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010 年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8): 485-508.
7. 赵志刚, 邱添, 梁志欣. 22 例肺炎型肺癌临床分析. 山东医药, 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. 卢旭东, 周兴菊, 陆益民. 肺癌患者胸水 CD40、MMP-12 水平的检测和临床意义. 临床肺科杂志, 2015, 20(7): 1174-1176.
10. 黄小伟, 王飞, 聂森, 等. 结核性渗出性胸膜炎及恶性胸腔积液患者 CEA、ADA 联合检测及 RO C 分析. 安徽医药, 2014, 18(8): 1475-1477.
11. 杜玲. 多指标联合检测对结核性胸腔积液的诊断效能研究. 国际检验医学杂志, 2017, 38(12): 1715-1717.
12. 张立群, 王云霞, 张轩, 等. 肺癌相关肿瘤标志物在肺部疾病患者血清中表达的对比分析. 中华医院感染学杂志, 2012, 22(20): 4478-4480.
13. 梁伟权, 胡佩村. 结核性胸膜炎患者治疗前后血清糖类抗原 125 水平的变化及临床意义. 国际呼吸杂志, 2015, 35(14): 1075-1077.
14. 张倩云. 胸水腺苷脱氨酶乳酸脱氢酶癌胚抗原对结核性胸膜炎和癌性胸腔积液的鉴别诊断价值探讨. 河北医学, 2015, 21(4): 576-578.
15. 夏静, 闫雪波, 刘荣玉. 联合检测 CEA、ADA、LDH 及血沉对胸腔积液性质判断的临床意义. 安徽医药, 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, 陈郁琳, 夏雨. 胸水 ADA、LDH 诊断结核性胸膜炎的临床效能评价. 检验医学, 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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