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@#Abstract: Objective To explore the relationship between peripheral blood and pleural effusion tuberculosis (TB) infection effector T cells, and to further evaluate the value of combined pleural effusion adenosine deaminase (ADA) for rapid diagnosis of tuberculous pleurisy. Methods The test data of 80 cases of tuberculous pleurisy and 70 cases of nontuberculous pleurisy treated in the Sixth People's Hospital of Nantong City from January 2017 to December 2020 were analyzed. The TBinfected effector T cells were also detected simultaneously in the peripheral blood and the pleural effusion by the T-SPOT technique, and the pleural effusion ADA was detected by the rate method. The subject operating characteristic curve (ROC) was applied to take the optimal pleural effusion ADA threshold to compare the sensitivity and specificity of different critical values. Person phase analysis was applied to analyze the correlation between peripheral blood and pleural effusion T-SPOT.TB. Data of peripheral blood, pleural effusion T-SPOT.TB and ADA were integrated. Results When pleural effusion ADA>45 U/L, the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 50.0% and 94.3%, respectively; when ADA > 25.15 U/ L, the sensitivity and specificity were 80.0% and 72.9%. When ADA > 45 U / L, pleural/ blood T-SPOT.TB spot ratio (spot forming cells, SFCs) > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 100% (highest); when 25.15 U/L< pleural effusion ADA ≤ 45 U/L, pleural/blood T-SPOT.TB spot ratio > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 92.3% (second). When pleural effusion ADA ≤ 25.15 U/L, and the pleural effusion/blood T-SPOT.TB spot number ratio > 2 times, with 83.3% specificity (the lowest of the three groups). Conclusions The level of pleural effusion ADA is one of the most used methods for diagnosing tuberculous pleurisy. Further combination of pleural effusion and blood T-SPOT.TB, if the ratio of pleural effusion / blood T-SPOT. TB spots is greater than 2 times, it can further improve the diagnosis rate of tuberculous pleurisy.
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Objective: To detect the levels of B7-H4 protein, adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in the malignant pleural effusion associated with lung cancer (LC-MPE) and tuberculous pleural effusion (TPK), and to evaluate the values of single and combined detection of B7-H4 protein, ADA and CEA in differential diagnosis of LC-MPE and TPK. Methods: A total of 202 samples of pleural effusion (PE) from 120 LC-MPE patients (LC-MPE group) and 82 TPE patients (TPE group) were collected. The levels of ADA and CEA and B7-H4 protein in PE were detected by the enzymatic, electrochemiluminescence and ELISA methods, respectively; and the receiver operating characteristic curve (ROC curve) was used to determine the diagnostic efficiencies of the above indexes alone or in combination, such as the sensitivity, the specificity, the Yoden index (YI)» and the area under ROC curve ( AUC). Results: The level of ADA in PE of the patients in TPE group was higher than that in LC-MPE group (P<0. 05); the levels of CEA and B7-H4 protein in PE of the patients in LC-MPE group were higher than those in TPE group ( P'-CO. 05). The ROC curve analysis results showed that the sensitivities of single detection of ADA, CEA and B7-H4 protein were 93.30%, 83.33% and 79.90%, respectively; the specificities were 86. 59%, 96.34% and 72. 50%, respectively; the AUC were 0. 927, 0. 925 and 0. 836, respectively. The combined detection of the three indexes had the highest diagnostic value; the sensitivity was 93. 90% , the specificity was 97. 50% , the YI was 0. 971, and the AUC was 0. 998. Conclusion: The combined detection of levels of ADA, CEA and B7-H4 protein in PE is superior to the single evaluation of each index, which can greatly improve the differential diagnosis efficiencies of LC-MPE and TPE.
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OBJECTIVE@#To study the clinical value of detecting carcinoembryonic antigen levels in pleural effusion (PCEA) and serum (SCEA) and their ratio (P/S) in the differential diagnosis of pleural effusions resulting from tuberculosis and lung cancer.@*METHODS@#This retrospectively study was conducted among 82 patients with pleural effusion caused by pulmonary tuberculous (TB; control group) and 120 patients with pleural effusion resulting from lung cancer in our hospital between April, 2016 and March, 2018. PCEA, SCEA and P/S were compared between the two groups and among the subgroups of lung cancer patients with squamous cell carcinoma (SqCa), adenocarcinoma (ACA), small cell carcinoma (SCLC). The receiveroperating characteristic curve (ROC) analysis was used to confirm the optimal critical value to evaluate the diagnostic efficiency of different combinations of PCEA, SCEA and P/S.@*RESULTS@#PCEA, SCEA and P/S were significantly higher in the overall cancer patients and in all the 3 subgroups of cancer patients than in the patients with TB ( < 0.05). The areas under the ROC curve of PCEA, SCEA and P/S were 0.925, 0.866 and 0.796, respectively; PCEA had the highest diagnostic value, whose diagnostic sensitivity, specificity, accurate rate, and diagnostic threshold were 83.33%, 96.34, 88.61%, and 3.26 ng/ml, respectively; SCEA had the lowest diagnostic performance; the diagnostic performance of P/S was between that of SCEA and PCEA, but its combination with SCEA greatly improved the diagnostic performance and reduced the rates of misdiagnosis and missed diagnosis. Parallel tests showed that the 3 indexes combined had significantly higher diagnostic sensitivity than each or any two of the single indexes ( < 0.05), but the diagnostic specificity did not differ significantly. The area under the ROC curve of combined detections of the 3 indexes was 0.941 for diagnosis of lung cancer-related pleural effusion, higher than those of any other combinations of the indexes.@*CONCLUSIONS@#The combined detection of PCEA, SCEA and P/S has a high sensitivity for diagnosis of lung cancer-related pleural effusion and provides important information for rapid and accurate diagnosis of suspected cases.
Subject(s)
Humans , Carcinoembryonic Antigen , Blood , Case-Control Studies , Diagnosis, Differential , Lung Neoplasms , Blood , Pleural Effusion , Blood , Diagnosis , Allergy and Immunology , Pleural Effusion, Malignant , Blood , Chemistry , Diagnosis , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Tuberculosis, PulmonaryABSTRACT
Objective To analyze the clinical value of combined detection of tuberculous T cell enzyme-linked immuno spot assay (T-SPOT.TB) and adenosine deaminase (ADA) in tuberculous pleurisy patients of different ages.Methods From February 2014 to February 2018,three hundred and thirty-six patients with pleural effusion were admitted to Hebei Thoracic Hospital.Among them,two hundred and fifty five cases were diagnosed as tuberculous pleurisy and 81 cases were diagnosed as non-tuberculous pleurisy.The patients were divided into two groups according to their age.The younger group (214 cases) was 16-59 years old and the older group (122 cases) was over 60 years old.The sensitivity and specificity of T-SPOT.TB combined with ADA in the diagnosis of tuberculous pleurisy were compared between the two groups.Results The sensitivity and specificity of T-SPOT.TB were 85.5％ (153/179) and 71.4％ (25/35) in the young and middle-aged group,73.7％ (56/76) and 58.7％ (27/46) in the old group,respectively.The sensitivity of the young and middle-aged group was significantly higher than that of the old group (x2 =4.990,P =0.045).The sensitivity and specificity of T-SPOT.TB combined with ADA were 98.9％ (177/179) and 94.3％ (33/35) in the young and middle-aged group,96.1％ (73/76) and 89.1％ (41/46) in the elderly group,respectively.There was no significant difference in sensitivity and specificity between the two groups (x2 =0.256,P=0.393、x2=0.655,P=0.218).Conclusion The diagnostic efficacy of T-SPOT.TB combined with ADA in patients with tuberculous pleurisy at different ages has been improved,especially for those who can not tolerate pleural biopsy and elderly patients.
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Objective To evaluate the diagnostic value of interferon-γ release assay of blood and pleural effusion for tuberculous pleurisy.Methods Fifty-six adult patients with suspected tuberculous pleurisy were enrolled in our study.The blood and pleural effusion interferon-γ release assay were measured by T-SPOT.TB test in 38 pleural tuberculosis patients and 18 nontuberculous pleurisy controls.The diagnostic sensitivity,specificity,predictive value of T-SPOT.TB in pleural effusion mononuclear cells (PE-MC) and peripheral mononuclear cells (PBMC) were analyzed.Results The sensitivities and specificities,positive predictive values and negative predictive values,respectively,of the PE-MC and PBMC for diagnosing were as follows:86.5％(95％ confidence interval[CI] 71.2％-95.5％) and 100％(95％CI 90.5％-100％);52.9％(95％CI 27.8％-77.0％) and 35.3％(95％CI 14.2％-61.7％);80.0％(95％CI 64.4％-90.9％) and 77.1％(95％CI 62.7％-88.0％);64.3％(95％CI 35.1％-87.2％) and 100％(95％CI 54.1％-100％).By ROC curve analysis,a cut-off value of 47SFC/2.5 × 105 cells in PE-MC showed a sensitivity of 89.2％ and a specificity of 88.2％.Conclusion T-SPOT.TB in PE-MC could be an accurate diagnostic method for tuberculous pleurisy in TB endemic settings.Moreover,47SFC/2.5 × 105 cells might be the optimal cut-off value for diagnosing tuberculous pleurisy.
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Objective To investigate the clinical diagnosis value of interferon gamma release assay (IGRA ) for pleural effusion in patients with tuberculous pleurisy .Methods 68 patients with tuberculous pleurisy (tu-berculous group) were included as object of study in Ganzi state people′s hospital ,and selected 70 patients with pneumonic pleurisy(pneumonia group) and 70 patients with malignancy (malignant group) as controls . Enzyme linked immunosorbent assay (ELISA) was used to detect interferon gamma release assay for tubercu-losis infected T cells (TB-IGRA ) in pleural effusion ,and were in progress blood TB-IGRA for tuberculous group .Results The IFN-γ level of patients in tuberculous group[179 .3(158 .1 -276 .2)ng/L] was higher than that those in pneumonia group[86 .7(55 .1 -162 .2)ng/L] and malignant group[92 .7(48 .1 -178 .3) ng/L] ,the difference was statistically significant (P＜0 .05) .The IFN-γ level of TB-IGRA for blood was low-er than that TB-IGRA for pleural effusion ,the difference was statistically significant (P＝0 .012) .The sensi-tivity ,specificity ,positive predictive value ,and negative predictive value of TB-IGRA for pleural effusion high-er than that blood TB-IGRA ,the difference was statistically significant (P＜0 .05) .The AUC of TB-IGRA for pleural effusion was higher than that blood TB-IGRA .Conclusion TB-IGRA for pleural effusion is an impor-tant laboratory index for the diagnosis of tuberculous pleurisy ,and its diagnostic efficiency is higher than that of blood TB-IGRA .
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Objective To analyze the value of serum Treg cell related factors and chemokines in patients with tuberculous pleurisy .Methods From July 2015 to December 2016 ,92 cases of tuberculous pleurisy in our hospital were selected as the observation group ,and 92 healthy persons at the same time were selected as the control group .The levels of Treg cell related factors[monocyte chemoattractant protein (MCP)-1 ,IP-10 ,CCL-3 and CCL-16] and IL-10 ,TGF-βand IL-35] were detected and compared in the two groups ,and the levels of these indexes were compared in different classifications and stages of tuberculous pleuritis .Results The ser-um Treg cell related factors and chemokine levels in the observation group were significantly higher than those in the control group (P<0 .05) .The expression level of tuberculous empyema was higher than that of dry pleuritis and exudative pleuritis ,the patients with exudative pleuritis were higher than those of dry pleuritis , and the patients with multiple pleuritis were higher than those with idiopathic and concomitant pleuritis ,the difference was statistically significant (P<0 .05) .Conclusion The serum Treg cell related factors and chemo-kines in patients with tuberculous pleurisy are highly expressed ,and the classification and staging of the dis-ease have great influence on the expression ,and the above indexes have high detection value in the patients with tuberculous pleurisy .
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Objective To evaluate the clinical value of T-SPOT.TB in the diagnosis of tuberculous pleu-risy. Methods A total of 180 cases of hospitalized patients with pleural effusion ( hospitalized between January 2013 to January 2015)were enrolled. Efficiency of T-SPOT.TB in the diagnosis of tuberculosis was evaluated and the effects of immune state on the number of spot forming cells were analyzed. Results The sensitivity and speci-ficity of the T-SPOT.TB in diagnosis of tuberculous pleural effusion were 82.24％(88/107)and 72.60％(53/73). The sensitivity and specificity of the T-SPOT.TB in immunocompromised patients were72.73％(40/55) and 52.63％(20/38).The sensitivity and specificity of the T-SPOT.TB in non-immunocompromised were 92.31％(48/52) and 94.29％(33/35).The sensitivity and specificity of those in non-immunocompromised were significantly higher than those in immunocompromised. ESAT-6 and CFP-10 specific SFCs of immunocompromised patients de-creased significantly compared with non-immunocompromised(Z is -26.817 and-43.756,P<0.05 ). Conclusion T-SPOT.TB has high sensitivity ,specificity in the diagnosis of tuberculous pleurisy.T-SPOT.TB and is a promising clinical test in the diagnosis of non-immunocompromised with suspected TB ,but its diagnostic performance in im-munocompromised patients is reduced compared with in non-immunocompromised patients.
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Objective To sum up the clinical manifestations and laboratory features for the diagnosis of pediatric tuberculous pleurisy,and to improve the recognition of this disease in early stage.Methods A retrospective study of 113 children diagnosed as tuberculous pleurisy from August 2006 to September 2014 in the Second Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University was conducted.Meanwhile,another 113 cases of children with mycoplasma pneumoniae pneumonia complicated with pleurisy were selected as control group.The general information,clinical symptoms,pleural effusion and imaging features between 2 groups were analyzed and compared by using SPSS 16.0 statistical software.Results The proportion of patients with cough in tuberculous pleurisy group and control group was 47.79％ (54/113 cases) and 99.12％ (112/113 cases) (x2 =76.33,P ＜ 0.01) respectively,and the proportion with severe cough was 3.70％ (2/54 cases) and 97.32％ (109/112 cases) (x2 =144.10,P ＜0.01),while the disease duration was 15.00 (10.00,30.00) days and 10.00 (8.00,14.50) days (W =8 668.00,P ＜ 0.01),respectively,and all the differences between 2 groups were significant.The proportion of patients with low fever,moderate fever,high fever and hyper fever was 8.65％ (9/104 cases),47.12％ (49/104 cases),44.23 ％ (46/104 cases) and 0,respectively in tuberculous pleurisy group,while the proportion was 0.90％ (1/111 cases),18.92％ (21/111 cases),79.28％ (88/111 cases) and0.90％ (1/111 cases) respectively in control group,and the difference between 2 groups was significant(W =9 064.00,P ＜ 0.01).The unilateral effusion ratio in tuberculous pleurisy group and the control group was 94.69％ (107/113 cases) and 71.68％ (81/113 cases),respectively (x2 =21.39,P ＜ 0.01).The monocyte ratio was higher in tuberculous pleurisy group [0.89 (0.76,0.93)] than that in the controlgroup [0.60 (0.30,0.78)] (W =888.50,P ＜ 0.01) and the level of protein in 2 groups was [51.00 (47.35,54.20) g/L] and [42.10 (37.85,46.15) g/L],respectively (W =842.50,P ＜ 0.01).The level of lactate dehydrogenase (LDH) in tuberculous pleurisy group[553.50 (358.00,749.25) U/L] was lower than that in the control group[1 189.10 (670.95,1 820.00) U/L] (W =2 186.00,P ＜ 0.01),and the differences were significant between 2 groups.In addition to pleural effusion,the high density was the main feature of imaging examination in 2 groups.The proportion of patients with atelectasis was 77.88％ (88/113 cases) and 4.42％ (5/113 cases) (x2 =125.90,P ＜ 0.01),while the proportion of patients with consolidation was 4.42％ (5/113 cases) and 72.57 ％ (82/113 cases),respectively (x2=110.80,P ＜ 0.01).All the differences between 2 groups were significant.The sputum culture-positive rate of mycobacterium tuberculosis was only 1.77％ (2/113 cases) and the other pathogen examinations were negative in tuberculous pleurisy group.Conclusions For patients with unilateral pleural effusion,when the onset only has fever (moderate-high fever),and respiratory symptoms are not clear or symptoms are not proportional to radiographic severity,or when high monocytes proportion (＞ 0.70) in pleural effusion and radiographic evidence of compression atelectasis are observed,tuberculous pleurisy should be considered and further questioning of the predisposing factors,purified protein derivative test should be taken so as to diagnose the tuberculous pleurisy at early stage.
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Objective:To investigate the clinical effect of dexamethasone combined with urokinase on the tuberculous pleurisy.Methods:From August 2013 to May 2016,190 cases of tuberculous pleurisy patients in our hospital were selected.All the patients were randomly divided into the observation group and control group with of 95 patients in each group,both groups were treated with anti tuberculosis treatment,the control group was given urokinase treatment,the observation group was given dexamethasone combined with urokinase treatment,both groups were treated for 1 month.After treatment,the total effective rate,incidence of adverse reactions,total drainage time of pleural effusion,total amount of pleural effusion,thrombin time and prothrombin time of two groups were compared.Results:All patients were well tolerated with injection during the treatment and there was no severe complication after treatment;the total effective rates in the observation group and the control group were 88.4％ and 72.6％,which was significantly higher in the observation group than that of the control group (P＜0.05).The total drainage time and total amount of pleural effusion in pleural effusion in the observation group were 7.56± 2.44 d and 2867.33± 456.10 mL,the control group were 9.44± 2.89 d and 1989.92± 444.20 mL,the total drainage time in the observation group was significantly shorter than that of the control group,and the total amount of pleural effusion was significantly higher than that of the control group(P＜0.05).After treatment,the pleural effusion thrombin time and prothrombin time in both groups were significantly higher than those before treatment (P＜0.05),which were higher in the observation group than those of the control group (P＜0.05).Conclusion:Dexamethasone combined with urokinase could prolong the thrombin time and prothrombin time,shorten the time of drainage of pleural effusion,increase the pleural effusion amount,with good safety and clinical effect in the treatment of tuberculous pleurisy.
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Objective To evaluate the clinical value of T-SPOT.TB in the diagnosis of tuberculous pleu-risy. Methods A total of 180 cases of hospitalized patients with pleural effusion ( hospitalized between January 2013 to January 2015)were enrolled. Efficiency of T-SPOT.TB in the diagnosis of tuberculosis was evaluated and the effects of immune state on the number of spot forming cells were analyzed. Results The sensitivity and speci-ficity of the T-SPOT.TB in diagnosis of tuberculous pleural effusion were 82.24％(88/107)and 72.60％(53/73). The sensitivity and specificity of the T-SPOT.TB in immunocompromised patients were72.73％(40/55) and 52.63％(20/38).The sensitivity and specificity of the T-SPOT.TB in non-immunocompromised were 92.31％(48/52) and 94.29％(33/35).The sensitivity and specificity of those in non-immunocompromised were significantly higher than those in immunocompromised. ESAT-6 and CFP-10 specific SFCs of immunocompromised patients de-creased significantly compared with non-immunocompromised(Z is -26.817 and-43.756,P<0.05 ). Conclusion T-SPOT.TB has high sensitivity ,specificity in the diagnosis of tuberculous pleurisy.T-SPOT.TB and is a promising clinical test in the diagnosis of non-immunocompromised with suspected TB ,but its diagnostic performance in im-munocompromised patients is reduced compared with in non-immunocompromised patients.
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Objective To discuss the clinical characteristics of advanced schistosomiasis combined with tuberculous pleuri?sy,so as to reduce misdiagnosis and mistreatment. Methods The clinical data of 15 patients suffered from advanced schistoso?miasis combined with tuberculous pleurisy were collected and analyzed retrospectively. Results The 15 patients all showed var?ious degrees of gastrointestinal symptoms with the performance of abdominal distension,digestive function and fatigue,14 pa?tients showed various degrees of edematous,9 patients showed stuffiness,4 patients had cough and expectoration,and 2 pa?tients had low fever and night sweats. Three cases were diagnosed within 2 days after admission,9 cases were diagnosed within one week after admission,and 3 cases were diagnosed after one week. Fifteen patients all received anti?tuberculosis treatment based on routine liver protection,diuresis,and symptomatic and supportive treatment. One patient with severe liver and kidney dysfunction died and one with gastrointestinal bleeding died. The remaining 13 patients were clinically cured. Conclusions The patients suffered from advanced schistosomiasis combined with tuberculous pleurisy do not show obvious tuberculosis poison?ing symptoms,and are easily misdiagnosed and missed?diagnosed. Therefore,physicians should pay much attention to the pa?tients whose pleural effusion cannot subside effectively or whose symptom cannot improve.
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Objective To explore the clinical value of tuberculous infection of T cells spot test (T-SPOT. TB)for diagnosing tuberculous pleurisy in immunocompromised patients. Methods The sensitivities of T-SPOT. TB,ADA, TB-DNA and tuberculosis antibodies to tuberculous pleurisy in 54 immunocompromised patients were compared.Among these patients,22 were retested by T-SPOT. TB after 2 months anti-tuberculosis treatment. Spot forming cells(SFCs) were compared before and after treatment. Results The diagnostic sensitivity of T-SPOT.TB (79.63%)was significantly higher than those of ADA (64.81%),TB-DNA (48.15%)and tuberculosis antibodies (55.56%) (P<0.05).22 patients were retested by the T-SPOT.TB after anti-TB treatment (2 months), the results showed that the positive rate of T-SPOT.TB was 90.91%,not significantly than previous tests (P<0.05).Both ESAT-6 and CFP-10 specific SFCs decreased significantly compared with those before anti-TB treatment (t=2.728 and 2.400,P<0.05 respectively). Conclusions T-SPOT.TB assay has satisfactory sensitivity and could be used in diagnosis of tuberculous pleurisy in immunocompromised patients.
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Objective To explore the value of T-SPOT.TB test in diagnosis of tuberculous pleurisy by comparing the T-SPOT.TB test, adenosine deaminase (ADA) of hydrothorax and tuberculosis antibody (TB-Ab). Methods 62 pleural effusion patients are included in the research , of which 32 cases have tuberculosis and 30 cases have no tuberculosis. All patients underwent T-SPOT.TB, pleural effusion ADA, and TB-Ab test. The results were compared with final clinical diagnosis for sensitivity and specificity evaluation. Results The sensitivity of T-SPOT.TB, ADA, TB-Ab were 90.6%, 71.9% and 62.5% respectively. The specificity of T-SPOT. TB, ADA, TB-Ab were 90.0%, 83.3% and 86.7% respectively. The sensitivity of T-SPOT.TB was the highest one among the three methods. The sensitivity of T-SPOT.TB has statistically significant difference compared with TB-Ab (P 0.05). Conclusions The T-SPOT.TB test had higher sensitivity and specificity for the diagnosis of tuberculous pleurisy , and had important reference value in early diagnosis of patients with tuberculous pleurisy. The T-SPOT.TB and TB-Ab combination examination had a complementary effect.
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Objective To investigate the clinical characteristics of tuberculous pleurisy(TP) in children in order to provide a good solution to the diagnosis and treatment of this disease.Methods Retrospective analysis was performed on the clinical data of 113 cases confirmed with TP who were admitted to Children's Hospital of Chongqing Medical University from January 2009 to December 2014.Results Among the 113 pediatric inpatients with TP,85 cases (75.2％) were sick for less than 1 month;92.9％ (105/113 cases) age ≥≥5 years old by onset;and 21.2％ (24/113 cases) patients demonstrated the contact with tuberculosis ,among whom 70.8％ (17/24 cases) attributed to linear relatives.The primary clinical manifestations included fever[96.5％ (109/113 cases)], cough [76.1％ (86/113 cases)] and chest pain[38.9％ (44/113 cases)] ,with as high as 89.0％ (87/109 cases) of the patients experiencing moderate or ardent fever.The positive rates of acid-fast bacilli smear and mycobacterium tuberculosis culture were 12.2％ (17/139 cases) and 22.7％ (15/66 cases), respectively;among the 41 patients who received pleural biopsy,40 cases (97.6％) were identified with the typical pathological changes in tuberculosis;and all 11 patients who received acid fast stain test on pleural tissues were positive to the test.Pulmonary parenchymatous lesions were revealed on CT examination in 89.1％ patients(98/113 cases),82.4％ (90/109 cases) of the patients had normal body temperature within a short period,and reduced effusion was revealed in 86 out of 98 patients who received repeated chest imaging examinations.Conclusions TP in children has acute onset typically, and the diagnosis of TP in children is more difficult than in adults,requiring considering multiple factors.Contact history with tubercular patients, etiological examination, pleural biopsy and chest CT are essential for the diagnosis of this disease.
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Objective To evaluate the diagnostic value of peripheral blood T-SPOT.TB and pleural effusion′s adenosine deami-nase(ADA)activity in patients with tuberculous pleurisy.Methods Sixty-two patients with suspected tuberculous pleurisy were enrolled in the study,whose peripheral blood T-SPOT.TB and pleural effusion ADA were measured and the best diagnostic thresh-old was determined by ROC curve.Results According to the diagnostic criteria of tuberculous pleurisy,24 patients were diagnosed with tuberculous pleurisy,33 were non-tuberculous pleurisy and 5 undiagnosed in the end.The sensitivity of T-SPOT.TB for the diagnosis of tuberculous pleurisy was 91.7 %,the specificity was 81.8%,Positive predictive value was 78.6%,negative predictive value was 93.1%.The ADA activity was (40.5±15.4)IU/L in tuberculous pleurisy group,which was higher than in non tubercu-lous pleurisy group[(2.4 ±9.5 )IU/L](P <0.01 ).The cut-off value of ADA was 22.5 IU/L in tuberculous pleurisy diagnosis, while its sensitivity and specificity were 83.3% and 84.8% respectively.The sensitivity of the combined detection of T-SPOT.TB and ADA was 95.8%.Conclusion The combined detection of peripheral blood T-SPOT.TB and pleural effusion ADA has a higher sensi-tivity in diagnosis of tuberculous pleurisy,and has important auxiliary diagnostic value for patients with suspected tuberculous pleurisy.
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Objective To investigate the significance of Th 17 cells, Treg cells and Th17/Treg cell-associated cytokines in the development of tuberculous pleurisy through detecting the expressions of Th 17 cells and Treg cells (CD4+CD25+Foxp3+) in CD4+T cells, analyzing concentrations of IL-17, IL-23, IL-6 and TGF-βin serum of patients with tuberculous pleurisy and healthy controls and measuring levels of IL -17, IL-23, IL-6 and TGF-βin hydrothorax of patients with tuberculous pleurisy .Methods Flow cytometry was used to detect expressions of Th 17 and Treg cells in peripheral blood of patients with tuberculous pleurisy and healthy controls.ELISA method was performed for quantitative detection of concentrations of IL -17, IL-23, IL-6 and TGF-βin serum and hydrothorax .Differences and correlations between the above measured data were analyzed by the statistical software SPSS 17.0.Results Compared with the healthy control group , the expressions of Th17 cells in peripheral blood of the patients were significantly increased (1.02%±0.20%vs.0.89%±0.13%, P=0.002<0.05), while the expressions of Treg cells were significantly decreased (4.64%±0.77%vs.5.10%±0.90%, P=0.000<0.05).Correspondingly, the ratio of Th17/Treg cells (0.25±0.07) in the patients were significantly higher than that in the healthy controls (0.17±0.05, P=0.000<0.05).Concentrations of IL-17, IL-23 and IL-6 in peripheral blood and in hydrothorax of the pa-tients were (17.49±3.94) ng/L, (90.42±23.06) ng/L, (4.54±1.02) ng/L and (26.13±5.98) ng/L, (122.26±31.71) ng/L, (5.31±0.74) ng/L respectively, which were remarkably higher than the levels of IL-17 (14.45±3.81) ng/L, IL-23 (77.55±20.26) ng/L and IL-6 (4.26±0.91) ng/L in control group. In tuberculous pleurisy group , concentrations of IL-17, IL-23 and IL-6 in hydrothorax were significantly higher than those in peripheral blood with P values of 0.000, 0.000 and 0.003.There was no difference be-tween IL-6 levels in peripheral blood from patients and IL-6 levels in peripheral blood from the healthy con-trols, P=0.274.In comparison with the control group , TGF-βlevels in peripheral blood and in hydrothorax of the patients were significantly decreased (3.95 ng/L±0.79 ng/L, 3.12 ng/L±0.77 ng/L vs.3.32 ng/L ±0.80 ng/L) .In tuberculous pleurisy patients , the expression of Th17 cells in peripheral blood was nega-tively correlated with Treg cells in peripheral blood (r=-0.684, P=0.000<0.05), but was positively relat-ed to the levels of IL-17, IL-23 and IL-6 (r=0.479, 0.441, 0.326, P=0.013, 0.015, 0.017).TGF-βlevel had significantly positive correlations with Treg cells in the peripheral blood of the patients (r=0.297, P=0.024), but no significant correlation with Th17 cells was found (r=0.091, P=0.659).Conclusion Th17/Treg cell-associated cytokines might regulate the expressions of Th 17 and Treg cells and inflammatory reaction.Changes of Th17 cells, Treg cells and related cytokines might be important immunopathological mechanisms for tuberculous pleurisy .
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PURPOSE: Tuberculous pleurisy is the most frequent extrapulmonary manifestation of tuberculosis. In spite of adequate treatment, pleural fibrosis is a common complication, but the mechanism has not been elucidated. This study is to determine whether epithelial to mesenchymal transition (EMT) of mesothelial cells occurs in tuberculous pleurisy. MATERIALS AND METHODS: Normal pleural mesothelial cells, isolated from irrigation fluids during operations for primary spontaneous pneumothorax, were characterized by immunofluorescence and reverse transcription polymerase chain reaction (RT-PCR). These cells were treated in vitro with various cytokines, which were produced in the effluents of tuberculous pleurisy. The isolated cells from the effluents of tuberculous pleurisy were analyzed by immunofluorescence and RT-PCR analysis. RESULTS: The isolated cells from the irrigation fluid of primary spontaneous pneumothorax had epithelial characteristics. These cells, with transforming growth factor-beta1 and/or interleukin-1beta treatment, underwent phenotypic transition from epithelial to mesenchymal cells, with the loss of epithelial morphology and reduction in cytokeratin and E-cadherin expression. Effluent analysis from tuberculous pleurisy using immunofluorescence and RT-PCR demonstrated two phenotypes that showed mesenchymal characteristics and both epithelial & mesencymal characteristics. CONCLUSION: Our results suggest that pleural mesothelial cells in tuberculous pleurisy have been implicated in pleural fibrosis through EMT.
Subject(s)
Humans , Cells, Cultured , Epithelial Cells/pathology , Epithelial-Mesenchymal Transition/physiology , Fluorescent Antibody Technique , Pleura/pathology , Reverse Transcriptase Polymerase Chain Reaction , Tuberculosis, Pleural/pathologyABSTRACT
After the start of anti-tuberculous treatment, paradoxical worsening of tuberculous lesions has been described. However, abdominal tuberculosis as paradoxical response is relatively rare. This report describes the 26-year-old female who suffered from peritoneal tuberculosis while treating tuberculous pleurisy with anti-tuberculous medications. It was considered as paradoxical response, rather than treatment failure or else. She was successfully managed with continuing initial anti-tuberculous medications. When a patient on anti-tuberculous medications is presented with abdominal symptoms, the possibility of paradoxical response should be considered to avoid unnecessary tests and treatments, which may result in more suffering of the patient. Herein, we report a case of peritoneal tuberculosis as paradoxical response while treating tuberculous pleurisy.
ABSTRACT
Tuberculosis is the most prevalent infectious disease in the world. Granuloma formation and caseous necrosis are hallmarks of M. tuberculosis infection and they represent the protective and inflammatory reactions in the infected tissues. The molecular mechanisms that mediate granuloma necrosis are still not well understood. Objectives: To immunolocalize and correlate the amounts of CD68+ macrophages and CD8+ lymphocytes to caseous necrosis extension in granulomas of tuberculous pleurisy. Methods: The study is a retrospective analysis of 30 pleural biopsies with histopathological diagnosis of chronic granulomatous pleurisy with caseous necrosis. These biopsies were classified according to necrosis intensity as minimal (N1), moderate (N2) and intense (N3). The number of granulomas was also observed and categorized as G1 (1 to 4 granulomas per section), G2 (5 to 8 granulomas per section), and G3 (more than 8 granulomas per section). Results: The means of CD68+ cells counts per mm² in N1, N2 and N3 categories of necrosis were 1,287 +/- 254, 1086 +/- 181 and 930 +/- 115 respectively. The means for CD8+ cells were 483.7 +/- 396, 366.3 +/- 43 and 558 +/- 53 cells per mm² in N1, N2 and N3 respectively. Conclusions: There were no significant statistical correlations between necrosis extension and cell counts. In analyzed biopsies, the number of CD68+ cells was significantly higher than the number of CD8+ cells.
La tuberculosis es una de las enfermedades más prevalentes en el mundo. La formación del granuloma junto con la necrosis caseosa son características propias de la infección por M. tuberculosis y representan reacciones inflamatorias y protectoras en los tejidos infectados. No se conocen bien los mecanismos moleculares que median la necrosis en el granuloma. Los objetivos fueron inmunolocalizar y correlacionar la cantidad de macrófagos CD68+ y linfocitos CD8+ con la extensión de la necrosis caseosa, en los granulomas de tuberculosis pleural. Análisis retrospectivo que incluyeron 30 biópsias con diagnóstico histopatológico de tuberculosis pleural granulomatosa crónica con necrosis caseosa. Estas biópsias fueron clasificadas según la intensidad de necrosis como mínima (N1), moderada (N2) e intensa (N3). También se determinó el número de granulomas, que fueron clasificados como G1 (1 a4 granulomas por sección), G2 (5 a 8 granulomas por sección), y G3 (más de 8 granulomas por sección). La cuantificación de células CD68+ por mm² en las categorías N1, N2 y N3 de necrosis fue de 1,287 +/- 254; 1086 +/-181 y 930 +/- 115, respectivamente. La cuantificación de las células CD68+ fue de 483,7 +/- 396; 366,3 +/- 43 y 558 +/- 53 células por mm² para N1, N2 y N3, respectivamente. No hubo correlación estadísticamente significativa entre la extensión de la necrosis y la cuantificación celular. El número de células CD68+ fue significativamente mayor que el número de células CD8+ en las biópsias analizadas.