结核性胸膜炎的临床诊断评估

目的探讨结核性胸膜炎(PT)临床诊断的评估方法。方法对140例胸腔积液的住院病人(其中70例确诊PT及70例确诊非PT)进行回顾性分析,计算胸液ADA、蛋白定量、淋巴细胞比值、血与胸液结核抗体、年龄、发热六个指标诊断PT的似然比(LR)以及灵敏度、特异度、阳性预测值和阴性预测值。结果胸液ADA最佳临界值的LR+值最高,其次是胸液与血结核抗体、年龄、胸液淋巴细胞比值、胸液蛋白、发热,若达到此六项变量的最佳诊断界值,患PT的可能性为99%以上,若此六项变量均阴性,患PT的可能性则下降为1%以下,只要考虑此六项中的任何四项变量达到最佳诊断界值,临床判断为PT的可能性可达97%。结论联合此六项指标可进行PT的临床诊断评估,有利于指导临床治疗。

Clinical evaluation of diagnosing pleural tuberculosis

Objective To evaluate the clinical factors of diagnosing pleural tuberculosis(PT).Methods 70 cases with PT and 70 pleurisy cases with Non-PT were analysed retrospectively.The LR,sensitivity,specificity,positive predictive value,and negative predictive value of pleural ADA,protein,lymphocyte ratio,TB-antibody in blood and pleural fluid,fever and age were calculated respectively.Results The variable with the highest LR was ADA,followed by TB-antibody,age,lymphocyte ratio,protein in pleural fluid and fever.If all six variables are positive,the probabilities of PT will be above 99%.If all variables are negative,the probabilities of PT will go down to be less than 1%.If four or above four variables are positive,the probabilities of pleural tuberculosis will be 97%.Conclusion The combination of these six variables can be used to evaluate the PT and to help to conduct the clinical treatment.