结核性胸膜炎90例临床诊断分析

目的 探讨结核性胸膜炎(PT)的临床诊断依据.方法 回顾性分析2007年12月至2009年12月我院收治的180例以胸腔积液住院患者,其中90例确认为PT,90例确认为非PT,计算胸液腺苷脱氨酶(ADA)、γ-干扰素(IFN-γ)、可溶性白细胞介素-2受体(sIL-2R)、血与胸液结核抗体、年龄、发热6项指标诊断PT的似然比(LR)、灵敏度、特异度、阳性预测值及阴性预测值.结果 6项指标中,胸液ADA最佳临界值的LR+最高,其次是血与胸液结核抗体、IFN-γ、年龄、sIL-2R、发热.若同时达到此6项指标的最佳诊断界值,患PT的可能性为99.9%以上,若6项指标均未达到最佳诊断界值,则患PT的可能性下降为1%以下.6项指标中任意4项满足条件时,患PT的可能性也在97%以上.结论 联合此6项指标对PT进行临床诊断分析,有利于早期诊断,指导治疗,避免并发症的发生.

Abstract：

Objective To investigate the clinical diagnostic evidences of pleural tuberculosis (PT).Methods One hundred and eighty patients with pleural effussion, whom were admited into our hospital from December 2007 to December 2009 ,were enrolled into this study. The clinical data of patients confirmed with PT ( n = 90) or Non-PT ( n = 90) were analyzed retrospectively. The likelihood ratios( LR), sensitivity, specificity,positive predictive value,and nagative predictive value of six indices including pleural ADA, IFN-γ, sIL-2R ,TB-antibody in blood and pleural effusion, age and fever status were calculated. Results The variable with the hightest LR+ was ADA optimal threshold, followed by TB-antibody, IFN-γ, age, sIL-2R, fever status, If all six variables reached the optimal threshold,the probabilities of PT exceeded 99.9%. However,if all variables didn't reached the optimal threshold, the probabilities of PT were less than 1%. Among all the six variables, any four or over four variables reached the optimal threshold, the probabilities of PT exceeded 97%. Conclusion The combination use of these six variables can aid the clinical analysis, early detection, and therapy instruction,complication prevention of PT.

Clinical analysis of 90 cases with pleural tuberculosis

Objective To investigate the clinical diagnostic evidences of pleural tuberculosis (PT).Methods One hundred and eighty patients with pleural effussion, whom were admited into our hospital from December 2007 to December 2009 ,were enrolled into this study. The clinical data of patients confirmed with PT ( n = 90) or Non-PT ( n = 90) were analyzed retrospectively. The likelihood ratios( LR), sensitivity, specificity,positive predictive value,and nagative predictive value of six indices including pleural ADA, IFN-γ, sIL-2R ,TB-antibody in blood and pleural effusion, age and fever status were calculated. Results The variable with the hightest LR+ was ADA optimal threshold, followed by TB-antibody, IFN-γ, age, sIL-2R, fever status, If all six variables reached the optimal threshold,the probabilities of PT exceeded 99.9%. However,if all variables didn't reached the optimal threshold, the probabilities of PT were less than 1%. Among all the six variables, any four or over four variables reached the optimal threshold, the probabilities of PT exceeded 97%. Conclusion The combination use of these six variables can aid the clinical analysis, early detection, and therapy instruction,complication prevention of PT.