ObjectiveTo analyze the clinical characteristics of patients with tuberculous pleural effusion and malignant pleural effusion and explore the value of laboratory indexes of pleural effusion in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion.MethodsThe clinical data and laboratory indexes of pleural effusion of patients with tuberculous pleural effusion and patients with malignant pleural effusion hospitalized in West China Hospital of Sichuan University between January and December 2017 were analyzed retrospectively. Those examinations with statistical significance were selected to establish a binary logistic regression model for diagnosing malignant pleural effusion from tuberculous pleural effusion. Hosmer-Lemeshow test was used to assess the goodness of fit of the logistic model, and a receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of the model.ResultsThe average age of the 128 patients with tuberculous pleural effusion was (51.60±21.02) years, and the average age of the 164 malignant pleural effusion was (63.52±11.87) years. Patients with tuberculous pleural effusion were prone to getting symptoms of cough, expectoration, fever, chest pain and tightness in breathing, with statistical significance (P<0.05). The level of adenosine deaminase in patients with tuberculous pleural effusion was (23.06±21.29) U/L, higher than that in malignant pleural effusion; the difference was statistically significant (P<0.05). The levels of albumin, glucose, carbohydrate antigen (CA) 125, CA19-9, carcinoembryonic antigen (CEA) and cyto-keratin 19 fragment antigen 21-1 in patients with malignant pleural effusion were higher than those in patients with tuberculous pleural effusion (P<0.05). Logistic regression analysis showed that CA125, CEA and glucose were introduced to model as the main effect. The area under the ROC curve was 0.914 [95% confidence interval (0.864, 0.964)], with an improved diagnostic efficiency.ConclusionsThe clinical manifestations of tuberculous pleural effusion and malignant pleural effusion are multifarious with low specificity. A joint detection of CA125, CEA and glucose in pleural effusion and the joint diagnostic model can identify tuberculous pleural effusion and malignant pleural effusion better.
ObjectiveTo explore the application value of plasma Epstein-Barr virus (EBV) DNA test in the clinical diagnosis of patients with nasopharyngeal carcinoma in non-high-incidence areas of Southwest China and its significance for monitoring patients after treatment. MethodsA total of 235 patients diagnosed with non-keratinized nasopharyngeal carcinoma between January 2014 and December 2015 were retrospectively collected. The plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment, the positive rates of the plasma EBV-DNA test before treatment and within 6 months of treatment, and the relationship between the positivity of plasma EBV-DNA within 6 months of treatment and the prognosis of nasopharyngeal carcinoma were analyzed. ResultsThe plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment was 69.79% (164/235), with a positive rate of 90.85% (149/164). A total of 131 patients were tested for EBV-DNA within 6 months of treatment, whose positive rate was 89.31% (117/131) before treatment and 21.37% (28/131) within 6 months of treatment, respectively, with a statistically significant difference (P<0.001). Comparing the prognosis of EBV-DNA positive patients and negative patients within 6 months of treatment, the difference in 3-year recurrence rate between the two groups was not statistically significant (10.71% vs. 3.88%, P=0.341); however, the 3-year metastasis rate (21.43% vs. 4.85%, P=0.016) and the 3-year disease progression rate (32.14% vs. 6.80%, P=0.001) of the EBV-DNA positive patients were higher than those of the EBV-DNA negative patients, and the log-rank test slao showed that the 3-year progression-free survival rate (67.86% vs. 93.20%, P<0.001) and the 3-year metastasis-free survival rate (78.57% vs. 95.15%, P=0.004) of the EBV-DNA positive patients were lower than those of the EBV-DNA negative patients. There was no statistically significant between-group difference in the 3-year progression-free survival curve when grouped by age, gender, or TNM staging (P>0.05).ConclusionsFor patients with non-keratinized nasopharyngeal carcinoma in non-high-incidence areas of Southwest China, EBV-DNA detection is important for the screening and diagnosis of nasopharyngeal carcinoma, and the positivity of EBV-DNA test within half a year of treatment is an important factor affecting the prognosis and progression of patients. Plasma EBV-DNA levels should be monitored regularly before and after treatment.