胸膜厚度联合外周血结核感染T细胞斑点试验鉴别诊断结核性与恶性胸腔积液

目的 评价胸膜厚度联合外周血结核感染T细胞斑点试验（T-SPOT.TB）鉴别结核性与恶性胸腔积液的价值。方法 纳入284例结核性胸膜炎患者（结核组）及213例恶性胸腔积液患者（恶性组）。采用超声测量胸膜厚度，并进行外周血T-SPOT.TB，比较组间结果差异；利用多因素logistic回归分析观察二者是否为恶性胸腔积液的独立危险因素。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价胸膜厚度、外周血T-SPOT.TB及二者联合鉴别结核性与恶性胸腔积液的效能，并以DeLong检验比较其效能差异。结果 2组间胸膜厚度及外周血T-SPOT.TB结果差异均存在统计学意义（P均<0.05），且此二项均为判断胸腔积液性质的独立危险因素，其OR分别为0.6795%CI（0.60，0.75），P<0.05]及6.7995%CI（4.44，10.39），P<0.05]。以胸膜厚度鉴别结核性与恶性胸腔积液的AUC为0.71，截断值取0.55 mm时，其诊断的敏感度为90.84%，特异度为45.08%；以外周血T-SPOT.TB鉴别诊断的AUC为0.72，敏感度为72.89%，特异度为70.89%；二者联合鉴别诊断的AUC为0.81，高于单一指标（P均<0.01），敏感度为65.49%，特异度为83.10%。结论 胸膜厚度和外周血T-SPOT.TB可用于鉴别结核性与恶性胸腔积液，且二者联合可提高鉴别特异度。

Pleural thickness combined with blood T-cell spot test of tuberculosis infection for differential diagnosis of tuberculous and malignant pleural effusion

Objective To explore the value of pleural thickness combined with blood T-cell spot test of tuberculosis infection (T-SPOT.TB) in differential diagnosis of tuberculous and malignant pleural effusion.Methods Totally 284 patients with tuberculous pleurisy (tuberculosis group) and 213 with malignant pleural effusion (malignant group) were enrolled. The pleural thickness was measured with ultrasound, peripheral blood T-SPOT.TB was performed, and the results were compared between groups. Multivariate logistic regression analysis was used to verify whether pleural thickness and peripheral blood T-SPOT.TB were independent risk factors of malignant pleural effusion.The receiver operating characteristic (ROC) curve was drawn, the area under the curve (AUC) was calculated to evaluate the efficacy of pleural thickness, peripheral blood T-SPOT.TB and both for judging tuberculous and malignant pleural effusion. DeLong test was used to compare the effectiveness.Results There were significant differences of pleural thickness and peripheral blood T-SPOT.TB results between groups (both P<0.05), and both pleural thickness and peripheral blood T-SPOT.TB were independent risk factors of malignant pleural effusion, with OR of 0.67 (95%CI 0.60, 0.75], P<0.05) and 6.79 (95%CI 4.44, 10.39], P<0.05), respectively. The AUC of pleural thickness for differentiation of tuberculous and malignant pleural effusion was 0.71, and taken 0.55 mm as the cut-off value, the sensitivity was 90.84% and the specificity was 45.08%. The AUC of peripheral blood T-SPOT.TB was 0.72, with sensitivity of 72.89% and specificity of 70.89%. The AUC of combination of both pleural thickness and peripheral blood T-SPOT.TB was 0.81, higher than single index (both P<0.05), with sensitivity of 65.49% and specificity of 83.10%.Conclusion Both pleural thickness and peripheral blood T-SPOT.TB could be used to distinguish tuberculous and malignant pleural effusion, and the combination of both could improve the diagnostic specificity.