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Diagnosing tuberculous pericarditis
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DOI：10.1093/qjmed/hcl123.png)
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摘要
En 中文
Background: Definitive diagnosis of tuberculous pericarditis requires isolation of the tubercle bacillus from pericardial fluid, but isolating the organism is often difficult. Aim: To improve diagnostic efficiency for tuberculous pericarditis, using available tests. Design: Prospective observational study. Methods: Consecutive patients (n=233) presenting with pericardial effusions underwent a predetermined diagnostic work-up. This included (i) clinical examination; (ii) pericardial fluid tests: biochemistry, microbiology, cytology, differential white blood cell (WBC) count, gamma interferon (IFN-gamma), adenosine deaminase (ADA) levels, polymerase chain reaction testing for Mycobacterium tuberculosis; (iii) HIV; (iv) sputum smear and culture; (v) blood biochemistry, ; and (vi) differential WBC count. A model was developed using 'classification and regression tree' analysis. The cut-off for the total diagnostic index (DI) was optimized using receiver operating characteristic (ROC) curves. Results: Fever, night sweats, weight loss, serum globulin (> 40g/1) and peripheral blood leukocyte count (< 10 x 10(9)/1) were independently predictive. The derived prediction model had 86% sensitivity and 84% specificity when applied to the study population. Pericardial fluid IFN-gamma >= 50pg/ml, concentration had 92% sensitivity, 100% specificity and a positive predictive value (PPV) of 100% for the diagnosis of tuberculous pericarditis; pericardial fluid ADA >= 40U/l had 87% sensitivity and 89% specificity. A diagnostic model including pericardial ADA, lymphocyte/neutrophil ratio, peripheral leukocyte count and HIV status had 96% sensitivity and 97% specificity; substituting pericardial IFN-gamma for ADA yielded 98% sensitivity and 100% specificity. Discussion: Basic clinical and laboratory features can aid the diagnosis of tuberculous pericarditis. If available, pericardial IFN-gamma is the most useful diagnostic test. Otherwise we propose a prediction model that incorporates pericardial ADA and differential WBC counts.
Keyword:
ACQUIRED-IMMUNODEFICIENCY-SYNDROME
ADENOSINE-DEAMINASE ACTIVITY
POLYMERASE-CHAIN-REACTION
CELL-BASED ASSAY
HIV-INFECTION
PLEURAL EFFUSIONS
MYCOBACTERIUM-TUBERCULOSIS
CARDIAC-TAMPONADE
DISEASE
LYMPHOCYTES
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