胸水中TB-DNA、TNF-α、IFN-γ检测对结核性胸水的诊断价值研究  

Diagnostic value of Mycobacterium tuberculosis DNA,tumour necrosis factor-α,and interferon-γ in tuberculous pleural effusion

作　　者：许西琳[1] 李俊岭[1] 杨军[2] 关键[1] 赵华[1] 周婷[2] 陈志刚[2] 张中宏[1] 宋丽军[1] 陈颖[1] 于颖佳[1] 

机构地区：[1]石河子大学医学院第一附属医院呼吸内科,832008 [2]石河子大学医学院第一附属医院中心实验室,832008

出　　处：《实用医学杂志》2007年第8期1151-1153,共3页The Journal of Practical Medicine

摘　　要：目的:了解结核性和恶性胸水中结核分支杆菌(TB)-DNA、肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ的水平,探讨三者在胸水鉴别诊断中的价值。方法:对75例胸水患者采用荧光定量聚合酶链反应(FQ-PCR)法检测胸水中的TB-DNA,使用夹心酶联免疫吸附法(ELISA)检测胸水中的TNF-α和IFN-γ。结果:结核性胸水中IFN-γ(M1039.9pg/mL,95%CI45.8～1077.4pg/mL)、TNF-α(M173.2pg/mL,95%CI36.0～775.1pg/mL)的水平均显著高于恶性胸水中IFN-γ(M49.4pg/mL,95%CI41.0～1058.3pg/mL)、TNF-α(M64.8pg/mL,95%CI33.8～486.9pg/mL)的水平(P<0.01)。结核性胸水中TB-DNA的阳性率为7.3%,恶性胸水中TB-DNA的阳性率为0%。以IFN-γ>70.0pg/mL诊断结核性胸水,其敏感度、特异度分别为92.7%、88.2%;以TNF-α>125.0pg/mL诊断结核性胸水,其敏感度、特异度分别为80.5%、82.4%。结论:检测胸水中TNF-α和IFN-γ的水平有助于结核性和恶性胸腔积液的鉴别诊断。Objective To explore the values of Mycobacterium tuberculosis DNA （TB-DNA）, tumour necrosis factor-α （TNF-α）, and interferon-γ （IFN-γ） in differential diagnosis of pleural effusions by detecting these biochemical components in tuberculous and malignant effusions. Methods FQ-PCR was performed to detect TB-DNA and enzymelinked immunoabsorbent assay （ELISA）was to TNF-α and IFN-γ in 75 patients with pleural effusion. Results The levels of IFN-γ/ （M 1 039.9 pg/mL,95%CI 45.8-1 077.4 pg/mL） and TNF-α（M 173.2 pg/mL,95%CI 36.0-775.1 pg/mL） in tuberculous effusion were significantly higher than those of IFN-γ/（M 49.4 pg/mL, 95%CI 41.0-1 058.3 pg/mL） and TNF- α（M 64.8 pg/mL,95%CI 33.8-486.9 pg/mL） in malignant effusion （P〈 0.01 ）. The positive rate of TB-DNA was 7.3% in tuberculous effusion but 0% in malignant effusion. When IFN-γ/greater than 70.0 pg/mL or TNF-α greater than 125.0 pg/ mL were diagnostic of tuberculous effusion, their sensitivity was 92.7% and 80.5%, and specificity was 88.2% and 82.4%, respectively. Conclusion The determination of IFN-γ/and TNF-α levels in pleural effusions may be beneficial to identification of tuberculous and malignant effusions.

关 键 词：胸腔积液 干扰素Ⅱ型 肿瘤坏死因子Α 结核性胸水 

分 类 号：R521[医药卫生—内科学]