IFN-γ和IL-2联合检测在老年结核性胸膜炎与恶性胸腔积液鉴别诊断中的应用OA

Objective To investigate the diagnostic value of multiple inflammatory markers combined with Myco-bacterium tuberculosis-specific interferon-γ(IFN-γ)and interleukin-2(IL-2)dual-factor detection in differen-tiating tuberculous pleural effusion(TPE)from malignant pleural effusion(MPE)in elderly patients.Methods A ret-rospective analysis was conducted on 140 patients aged ≥60 years with pleural effusion admitted to Lanzhou Pulmonary Hospital from January 2023 to December 2024.Among them,80 cases were diagnosed as TPE and 60 as MPE.Laboratory parameters including Mycobacterium tuberculosis-specific IFN-γ and IL-2,erythrocyte sedimentation rate(ESR),serum C-reactive protein(CRP),serum lactate dehydrogenase(LDH),serum adenosine deaminase(ADA),and pleu-ral fluid LDH and ADA were collected and compared between the two groups.Diagnostic performance of each indicator and their combinations was evaluated by receiver operating characteristic(ROC)curve analysis.Results There was no significant difference in mean age between the TPE and MPE groups(P＞0.05),but the proportion of males was signifi-cantly higher in the TPE group(P＜0.05).Compared with the MPE group,TPE patients showed significantly higher lev-els of IFN-γ,IL-2,ESR,serum ADA,and pleural ADA(P＜0.05),while serum LDH was significantly lower(P＜0.05).No significant differences were found in serum CRP or pleural LDH(P＞0.05).Using IFN-γ≥7 pg/mL and/or IL-2 ≥20 pg/mL as diagnostic thresholds yielded a sensitivity of 82.5％,specificity of 85.0％,and overall accuracy of 83.6％.In MPE patients,dual IFN-γ and IL-2 positivity demonstrated the highest specificity(98.33％).The area under the curve(AUC)values for IFN-γ,IL-2,and combined dual-factor detection were 0.820,0.807,and 0.823,respectively.The dual-factor AUC was significantly higher than those of ESR(Z=2.094,P=0.036),serum LDH(Z=3.471,P=0.000),and serum ADA(Z=2.500,P=0.012),but not significantly different from pleural ADA(Z=0.535,P=0.592).Moreover,combining dual-factor detection with pleural ADA yielded an AUC of 0.897(95％CI:0.834-0.942),significantly higher than either test alone(Z=2.056,P=0.040;Z=3.082,P=0.002,respectively).Conclusion Combined detection of Mycobacterium tuberculosis-specific IFN-γ and IL-2 provides valuable diagnostic information for differentiating tuberculous pleural effusion from malignant pleural effusion in elderly pa-tients.Dual positivity(IFN-γ/IL-2)offers the highest specificity,and the addition of pleural ADA measurement fur-ther enhances diagnostic accuracy.