Diagnostic value of cell-free DNA detection in tuberculous pleurisy
Objective To assess the diagnostic efficacy of the cell-free Mycobacterium tuberculosis DNA testing(CF-TB)in tuberculous pleurisy.Methods A total of 71 patients diagnosed with tuberculous pleurisy and 35 patients with non-tuberculous pleurisy were selected from the Fifth People's Hospital of Wuxi between January to December 2022.The standard pleural puncture was conducted to collect pleural effusion,which was then utilized for Mycobacterium tuberculosis culture,GeneXpert Mycobacterium tuberculosis/rifampicin resistance(GeneXpert MTB/RIF),CF-TB,and adenosine deaminase(ADA)testing.Blood samples were subjected to tuberculosis infection T-cell spotting test(T-SPOT.TB)assay.The receiver operator characteristic curve(ROC)was applied to obtain the optimal cut-off value for pleural fluid CF-TB and to compare the diagnostic performance of CF-TB with other methods.Data analysis was conducted using SPSS 22.0 software,with statistical significance defined as P＜0.05.Results The ROC curve analysis determined that the optimal cycle threshold(Ct)value for diagnosing tuberculous pleurisy using CF-TB in pleural fluid was 38.489,with a sensitivity of 91.5％and specificity of 97.1％.In comparison,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T-SPOT.TB and pleural fluid ADA in diagnosing tuberculous pleurisy were 86.0％,71.4％,86.0％,71.4％,81.1％,and 55.0％,91.4％,92.9％,50.8％,67.0％,respectively,all of which were lower than the diagnostic efficiency of CF-TB.Furthermore,the specificity of pleural fluid CF-TB in diagnosing tuberculous pleurisy(97.1％)was not significantly different from GeneXpert MTB/RIF(100％)and Mycobacterium tuberculosis culture(100％),but its sensitivity(91.5％)was significantly higher than both GeneXpert MTB/RIF(19.7％)and Mycobacterium tuberculosis culture(28.2％),with a statistically significant difference(P＜0.001).Conclusions Compared to the conventional gold standard for diagnosing tuberculous pleurisy,CF-TB exhibits a higher sensitivity and its specificity is superior to that of tuberculosis immunological test.Consequently,CF-TB can serve as a valuable complement to other traditional detection methods in aiding the diagnosis of tuberculous pleurisy.
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