目的 分析76例工业区来源的结核性胸膜炎患者的患病相关因素及临床特征。方法 回顾性收集2018年1月—2020年12月于深圳市中西医结合医院住院的76例工业区来源的结核性胸膜炎患者(观察组)的病历资料和57例同期同区域来源的健康体检者(对照组)的病历资料。运用统计学分析工业区结核性胸膜炎的患病相关因素及临床特征。结果 2组的比较当中,年龄、白蛋白水平、身高、体质量、体质量指数之间的差异具有统计学意义(P<0.05);而多因素Logistic回归分析结果显示,年龄及白蛋白水平则是工业区结核性胸膜炎的独立保护因素(P<0.001,OR=0.728,95% CI:0.634～0.836以及P<0.001,OR=0.908,95% CI:0.874～0.944);工业区结核性胸膜炎的临床症状为咳嗽(71.05%)、发热(48.68%)、胸痛(47.37%),发病季节以春秋季节(27.63%和32.90%)为主。结论 工业区结核性胸膜炎的独立影响因素是年龄及白蛋白水平,临床症状主要为咳嗽、发热、胸痛,好发于春秋季节。

Objective To analyze the relative factors and clinical characteristics of 76 patients with tuberculous pleurisy from industrial area. Methods The medical records of 76 patients with tuberculous pleurisy from industrial areas (observation group) and 57 healthy subjects from the same period and region (control group) who were hospitalized in Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2020 were retrospectively collected. The correlative factors and clinical characteristics of tuberculous pleurisy in industrial area were analyzed by statistics. Results There were statistically significant differences in age, albumin level, height, weight and body mass index between the two groups (P<0.05). Multivariate logistic regression analysis showed that age and albumin level were independent protective factors for tuberculous pleurisy in industrial areas (P<0.001, OR=0.728, 95% CI: 0.634~0.836 and P<0.001, OR=0.908, 95% CI: 0.874~0.944). The clinical symptoms of tuberculous pleuritis in industrial areas were cough (71.05%), fever (48.68%) and chest pain (47.37%), and the onset season was mainly in spring and autumn (27.63% and 32.90%). Conclusions The independent influencing factors of tuberculous pleuritis in industrial area are age and albumin level. The main clinical symptoms are cough, fever and chest pain, which usually occur in spring and autumn.

目的 研究结核感染T细胞斑点试验(T-SPOT.TB)技术联合胸水腺苷脱氨酶(ADA)在结核性胸膜炎中的诊断价值。方法 在研究中选取2016年1月—2018年12月在梅州市人民医院呼吸内科和全科医学科住院的60例结核性胸膜炎患者作为研究对象,对所有患者均进行血T-SPOT.TB、胸水ADA检查,比较血T-SPOT.TB、胸水ADA及胸水ADA联合血T-SPOT.TB检查三种检测方式的诊断符合率、误诊率、漏诊率、阳性预测值、阴性预测值、准确性、特异度、敏感度。结果 胸水ADA、血T-SPOT.TB以及血T-SPOT.TB联合胸水ADA检测方式的诊断符合率分别为75%、80.00%、93.33%,联合检测方式的诊断符合率高于单一检测方式的诊断符合率(P＜0.05)。血T-SPOT.TB联合胸水ADA检测方式的误诊率、漏诊率分别为0.00%、1.72%,低于胸水ADA、T-SPOT.TB检测方式(P＜0.05);血T-SPOT.TB联合胸水ADA检测方式的阳性预测值、阴性预测值分别为100.00%,67.78%,联合检测方式的阴性预测值高于其单一检测方式(P＜0.05)。T-SPOT.TB联合胸水ADA检测方式的特异度及敏感度分别为98.79%、97.87%,联合检测方式的敏感度高于其单一检测方式(P＜0.05)。血T-SPOT.TB检测方式与胸水ADA检测方式仅在特异度方面不存在统计学差异(P＞0.05)。结论 在对结核性胸膜炎患者进行诊断时,血T-SPOT.TB联合胸水ADA具有较高的诊断价值,值得应用。

Objective To investigate the diagnostic value of t-spot test (T-SPOT.TB) combined with adenosine deaminase (ADA) in tuberculous pleuritis. Methods 60 patients with tuberculous pleurisy hospitalized in the departments of respiratory medicine and general practice of Meizhou People's Hospital between January 2016 and December 2018 were enrolled in the study. All the patients were examined by blood T-SPOT.TB and ADA. The diagnostic coincidence rate, false positive rate,false negative rate, positive predictive value, negative predictive value, accuracy, specificity and sensitivity of the three detection methods of T-SPOT.TB, ADA, and T-SPOT.TB combined with ADA were also analyzed. Results The diagnostic coincidence rate of ADA, T-SPOT.TB and T-SPOT.TB combined with ADA was 75%, 80.00% and 93.33%, respectively. The diagnostic coincidence rate of the combined test was higher than that of the detection method (P<0.05). The misdiagnosis rate and missed diagnosis rate of blood T-SPOT.TB combined with ADA were 33.3% and 1.75%, respectively. The positive predictive value and negative predictive value of blood T-SPOT.TB combined with ADA test were 98.2% and 66.6%, respectively. The negative predictive value of combined T-SPOT.TB combined with ADA test was higher than that of the single test (P<0.05). The specificity and sensitivity of the T-SPOT.TB combined with ADA were 98.79% and 97.87%, respectively, and the sensitivity of the combined test was higher than that of the single test (P<0.05). Conclusion Blood T-SPOT.TB combined with pleural effusion ADA has higher diagnostic value in patients with tuberculous pleurisy and is worthy of clinical application.

目的 分析并探讨T细胞斑点技术诊断结核性胸膜炎的临床价值。方法 将2014年5月—2016年5月收治61例的结核性胸膜炎的患者和61例非结核性胸膜炎的患者同时行外周血和胸水的T细胞斑点实验,对各组数据进行统计学处理与分析。结果 结核组血T-SPOT的阳性率为88.52%,高于非结核组的16.39%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为88.52％、83.61%、85.71%、86.44%、5.40、0.14、0.72。结核组胸水T-SPOT的阳性率为90.16%,高于非结核组的8.20%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82。联合外周血及胸水T-SPOT检测阳性率为91.80%,特异度为93.44%,阳性似然比为14.00,阴性似然比为0.09,youden指数为:0.85。结论 T细胞斑点实验检测对结核性胸膜炎有较高的临床诊断价值,外周血及胸水T-SPOT联合检测可提高诊断率,可作为结核性胸膜炎快速早期诊断的有效辅助手段。

Objective To analysis the value of T-SPOT.TB in the diagnosis of tuberculous pleurisy. Methods A total of 61 patients with clinically suspected tuberculous pleurisy (group A) and 61 cases of other diseases caused by pleural effusion (group B)admitted from May 2014 to May 2015 from the Guangzhou Chest Hospital had peripheral blood T-SPOT.TB and pleural effusion T-SPOT.TB,for each group of data for statistical processing and analysis. Results The positive rate of T-SPOT in the blood of the group A was 88.52%, which was higher than group B, (P<0.001) (16.39.0%). And the sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 88.52%, 83.61%,85.714%, 86.44%, 540, 0.14, 0.72 respectively by peripheral blood T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of pleural effusion T-SPOT in the group A was 90.16%, which was also higher than group B (P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82 respectively by pleural effusion T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of the joint tests of T-SPOT in peripheral blood and in peripheral blood was 91.80%, the specificity was 93.44%, the positive likelihood ratio was 14, the negative likelihood ratio was 0.09, and the youden index was 0.85. Conclusion T-SPOT.TB for the diagnosis of tuberculous pleurisy has a higher clinical value in the diagnosis. The joint tests of T-SPOT in peripheral blood and in pleural effusion may improve the positive rate in the diagnosis of tuberculous pleurisy. The joint tests of T-SPOT in peripheral blood and in pleural effusion have an important reference for diagnosing suspected tuberculous pleurisy quickly, early and accurately.

      目的   探讨分析超声引导下胸膜活检（USPB）联合胸腔积液检验对于临床确诊结核性胸膜炎的应用价值。方法   选取2021年6月—2023年6月广州市胸科医院收治的96例临床诊断为结核性胸膜炎（渗出性胸膜炎）的患者为研究对象，分别使用胸腔积液检验（包含胸腔积液腺苷脱氨酶及细菌培养）、USPB、两者联合三种方法诊断，计算其准确率、特异度及灵敏度并进行分析。结果   胸腔积液诊断准确率73.96%、灵敏度72.84%，USPB诊断准确率为85.42%、灵敏度82.71%，两者联合诊断准确率为88.54%，灵敏度90.12%，较胸腔积液检验单独诊断准确率及灵敏度明显升高（P＜0.05），胸腔积液、USPB、两者联合诊断特异度差异（P＞0.05）无统计学意义。结论  USPB联合胸腔积液检验对结核性胸膜炎的确诊具有较高临床价值。

       Objective  To investigate the value of ultrasound-guided pleural biopsy（USPB）combined with  pleural effusion test in the diagnosis of tuberculous pleurisy．Methods  A total of 96 patients with tuberculous pleurisy（exudative pleurisy）admitted to the Guangzhou Chest Hospital from June 2021 to June 2023 were selected．The accuracy，specificity，and sensitivity of pleural effusion test（including adenosine deaminase and bacterial culture），USPB，and their combination were calculated and analyzed．Results  The diagnostic accuracy of pleural effusion was 73.96% and the sensitivity was 72.84%．The diagnostic accuracy of USPB was 85.42% and the sensitivity was 82.71%．The diagnostic accuracy 88.54% and sensitivity 90.12% of USPB combined with pleural effusion test were significantly higher than that of pleural effusion alone（P＜0.05），but there was no significant difference in the diagnostic specificity of pleural effusion，USPB and combination of them（P＞0.05）．Conclusions  USPB combined with pleural effusion test has high clinical value in the diagnosis of tuberculous pleurisy．