关键词: 结核,胸膜/诊断, 抗体,细菌, 组织技术

Abstract: Objective To probe value of testing of a variety of antibodies against Mycobacterium tuberculosis and pleural biopsy in diagnosis of tuberculous pleurisy.Methods 121 cases of tuberculous pleurisy (60 of them had also been with pulmonary tuberculosis) and 44 cases of carcinomatous pleurisy were subject to testing of antibodies (PPD-lgG, LAM-IgG Card, TB Dot Card, ICT-TB Card) against Mycobacterium tuberculosis in both serum and chest fluid, while 72 cases of tuberculous pleurisy were subject to pathological examination of pleural biopsy.Results Positive rates of 4 antibodies in serum was 75.6%, 30.7%,44.7% and 35.1% respectively, while counterparts in carcinomatous pleurisy was 43.2%, 17.1%,11.4% and 2.6% respectively. Positive rates of 4 antibodies in chest fluid was 81.7%,24.0%,27.1% and 22.7%, while counterparts in carcinomatous pleurisy was 51.2%,14.7%, 5.9% and 2.8%. Positive rates registered in both serum and chest fluid were higher than that of in carcinomatous pleurisy, positive rates of those tuberculous pleurisy with pulmonary tuberculosis were higher than that of in simple tuberculous pleurisy. PPD-lgG had the highest sensitivity but had the least specificity (56.8% in serum and 48.8% in chest fluid) and had obvious cross with carcinomatous chest fluid; as for LAM-lgG Card, TB-Dot Card, ICT-TB Card, specificity in serum was 82.9%, 88.6% and 97.4% respectively and specificity in chest fluid was 85.3%, 94.1% and 97.2% repectively, they had higher specificity than PPD-lgG but had lower sensitivity than PPD-lgG. Except for PPD-lgG, positive rates of antibodies in chest fluid were all slightly lower than that of in serum. If two positive rates were combined together as set A: PPD-lgG and TB-Dot Card or set B: PPD-lgG and ICT-TB Card, specificity of diagnosis by positive rates from serum could achieve to 94.3%～100% and specificity of diagnosis by positive rates from chest fluid could achieve to 91.4%～97.2%. Combined positive rate in serum was 36%～42.98% and in chest fluid was 17%～23%, which can be referred to by clinical differential diagnosis. 34 cases of the 72 cases subject to pleural biopsy were positive (47.2%), and the positive rates had close bond with disease course. Those cases whose onset was within 2 months had the highest positive rate of 75.5% (25/34).Conclusion Diagnosis of pathological pleural biopsy values important in diagnosis of tuberculous pleurisy, combined testing of various antibodies has some degree of significance of reference for diagnosis of tuberculous pleurisy.

Key words: Tuberculosis,pleura/diagnosis, Antibody,bacterium, Histological technology