BACKGROUND Diagnosing tuberculous pleurisy (TP) remains a clinical challenge and the best method to diagnose it is controversial. Although several studies have investigated the performance of pleural fluid (PF) T-SPOT for pleural tuberculosis (plTB) diagnosis, the heterogeneity of its accuracy exists. Therefore, we performed an updated meta-analysis of the existing evidence on the utility of PF T-SPOT to diagnose TP. METHODS PubMed and EmBase were searched for relevant English articles up to July 29, 2019. Statistical analysis was performed using Stata, Revman, and Meta-Disc. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic (SROC) curves and the area under the curve (AUC) were used to summarize the overall diagnostic performance. RESULTS A total of 13 studies (997 patients with TP and 656 patients without TP) were identified and enrolled to meta-analysis, giving the following pooled values for diagnostic accuracy of PF T-SPOT: sensitivity, 0.91 (95% CI, 0.89-0.92, I2 = 80.9%); specificity, 0.88 (95% CI, 0.86-0.91, I2 = 87.3%); PLR, 6.28 (95% CI, 2.88-13.69, I2 = 93.3%); NLR, 0.12 (95% CI, 0.07-0.21, I2 = 84.9%); DOR, 59.74 (95% CI, 24.13-147.93, I2 = 78.3%); and the area under the SROC curve, 0.95 (95% CI, 0.93-0.97). CONCLUSIONS Our meta-analysis suggests that PF T-SPOT has important diagnostic value for plTB. However, the standardization of the operating procedure needs to be further promoted, which would make the results more credible.

中文翻译：

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胸水 T-SPOT 对结核性胸膜炎的诊断价值：更新的荟萃分析

背景 诊断结核性胸膜炎 (TP) 仍然是一项临床挑战，诊断它的最佳方法是有争议的。尽管有几项研究调查了胸腔积液 (PF) T-SPOT 对胸膜结核 (plTB) 诊断的性能，但其准确性存在异质性。因此，我们对 PF T-SPOT 诊断 TP 的效用的现有证据进行了更新的荟萃分析。方法检索PubMed和EmBase截至2019年7月29日的相关英文文章，使用Stata、Revman和Meta-Disc进行统计分析。确定了汇总的敏感性、特异性、阳性似然比 (PLR)、阴性似然比 (NLR) 和诊断优势比 (DOR)。总结接受者操作特征 (SROC) 曲线和曲线下面积 (AUC) 用于总结整体诊断性能。结果 共有 13 项研究（997 名 TP 患者和 656 名非 TP 患者）被确定并纳入荟萃分析，给出了以下 PF T-SPOT 诊断准确性的汇总值：敏感性，0.91（95% CI，0.89- 0.92, I2 = 80.9%); 特异性，0.88（95% CI，0.86-0.91，I2 = 87.3%）；PLR，6.28（95% CI，2.88-13.69，I2 = 93.3%）；NLR，0.12（95% CI，0.07-0.21，I2 = 84.9%）；DOR，59.74（95% CI，24.13-147.93，I2 = 78.3%）；SROC 曲线下面积为 0.95（95% CI，0.93-0.97）。结论 我们的荟萃分析表明 PF T-SPOT 对 plTB 具有重要的诊断价值。但操作流程的标准化有待进一步推进，