胸膜结核的实验室诊断:一个未解之谜。

IF 1.4 4区 医学 Q4 IMMUNOLOGY
Atish Mohapatra , Ujjwala Gaikwad , Ranganath T. Ganga , Pratibha Sharma
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引用次数: 0

摘要

背景:胸膜结核(TB)的诊断具有挑战性,目前的诊断方法是多学科的,除了实验室参数外,还包括临床放射学方法。本研究旨在探讨所有可用参数在胸膜结核诊断中的作用。方法:于2021年2月至11月在恰蒂斯加尔邦一家三级医院对疑似胸膜结核患者进行横断面研究。在征得同意并获得临床放射学信息后,收集胸膜液并使用现有的微生物参数进行生化分析和结核分枝杆菌检测。结果:170例患者中,明确结核26例(微生物学确诊),可能结核22例(临床放射学确诊),无结核122例。坏死性纵隔淋巴结病、颈部淋巴结病和局部积液是重要的影像学表现。在生化参数中,受试者工作特征(ROC)截断40.0 U/L;AUC= 0.889)证明腺苷脱氨酶(ADA)是比LDH更好的生物标志物(ROC cut off为442.0 IU/L;AUC = 0.645)。在所有可用的微生物参数中,基于试剂盒的核酸扩增试验(CBNAAT)表现较好,鉴定出(6/7;85.71%)胸膜结核病例与微生物参考标准(MRS)比较。与复合标准品(CRS)比较,分枝杆菌生长指示管(MGIT)的鉴定效果优于其他微生物指标(19/48;39.5%),而CBNAAT和Truenat均能识别(6/16;37.5%)和(12/32);分别为37.5%)。结论:结合临床和放射学特征,ADA评估对确定或反驳微生物阴性胸膜结核的诊断很有帮助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Laboratory diagnosis of pleural tuberculosis: An unsolved enigma

Background

Pleural Tuberculosis (TB) diagnosis is challenging and the current diagnostic approach is multidisciplinary involving clinico-radiological methods in addition to laboratory parameters. The study aims to explore the role of all available parameters for pleural TB diagnosis.

Methods

A cross-sectional study on suspected pleural TB patients was conducted at a tertiary care hospital in Chhattisgarh from February to November 2021. After obtaining consent and clinico-radiological information, pleural fluid was collected and tested for biochemical profile and detection of Mycobacterium tuberculosis using available microbiological parameters.

Results

Out of 170 subjects, 26 had Definite TB (Microbiologically confirmed), 22 had Probable TB (clinico-radiologically confirmed), and 122 had No-TB. Necrotizing mediastinal lymphadenopathy, cervical lymphadenopathy & loculated effusion were significant radiological findings. Amongst biochemical parameters, (Receiver Operating Characteristic (ROC) cut off 40.0 U/L; AUC = 0.889) of Adenosine Deaminase (ADA) was proved to be a better biomarker than LDH (ROC cut off 442.0 IU/L; AUC = 0.645). Out of all available microbiological parameters, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) performed better by identifying (6/7; 85.71 %) pleural TB cases when compared against Microbiological Reference Standards (MRS). While compared against Composite Reference Standards (CRS), Mycobacteria Growth Indicator Tube (MGIT) performed better than other microbiological parameters by identifying (19/48; 39.5 %), while both CBNAAT and Truenat could identify (6/16; 37.5 %) and (12/32; 37.5 %) respectively.

Conclusion

In association with clinical and radiological features, ADA estimation is quite helpful in establishing or refuting the diagnosis of microbiologically negative pleural tuberculosis.
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来源期刊
CiteScore
2.20
自引率
0.00%
发文量
154
审稿时长
73 days
期刊介绍: Manuscripts of high standard in the form of original research, multicentric studies, meta analysis, are accepted. Current reports can be submitted as brief communications. Case reports must include review of current literature, clinical details, outcome and follow up. Letters to the editor must be a comment on or pertain to a manuscript already published in the IJMM or in relation to preliminary communication of a larger study. Review articles, Special Articles or Guest Editorials are accepted on invitation.
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