胸腔积液中纤溶因子的检测及其临床意义  

The Differential Diagnostic Value of Major Fibrinolytic Parameters in Pleural Fluid

作　　者：王玺[1] 时国朝[1] 李庆云[1] 韩力[1] 万欢英[1] 邓伟吾[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸科,上海200025

出　　处：《中国呼吸与危重监护杂志》2009年第2期146-150,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨主要纤溶因子指标在胸腔积液鉴别诊断中的临床意义。方法对初次胸穿获得的胸腔积液进行纤溶活性的检测。应用ELISA法测定组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)浓度,应用乳胶增强型免疫比浊法(ITM)测定D二-聚体浓度。结果84例胸腔积液中,恶性胸腔积液40例,感染性胸腔积液33例,漏出液11例。恶性胸腔积液和漏出液中t-PA浓度均高于感染性胸腔积液[(52.49±31.46)ng/mL和(58.12±23.14)ng/mL比(37.39±22.44)ng/mL,P<0.05],但前两者间差异无统计学意义(P>0.05)。恶性胸腔积液和感染性胸腔积液中PAI-1浓度均高于漏出液[(164.86±150.22)ng/mL和(232.42±175.77)ng/mL比(46.38±16.13)ng/mL,P<0.01],但前两者间差异无统计学意义(P>0.05)。恶性胸腔积液、漏出液及感染性胸腔积液三组D二-聚体的浓度两两比较有显著差异[(23.66±25.18)mg/L、(6.36±10.87)mg/L和(66.90±42.17)mg/L,P<0.01]。以t-PA>38.7 ng/mL(ROC曲线下面积为64.0)、D-二聚体<27.0 mg/L(ROC曲线下面积为85.5)为界值或者两者联合,诊断恶性胸腔积液的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为60.0%、63.6%、66.7%、56.8%和61.6%;84.8%、72.5%、85.3%、71.8%和78.1%;92.5%、60.6%、74.0%、87.0%和78.1%。结论不同原因所致的胸腔积液中纤溶因子t-PA、PAI-1及D-二聚体浓度存在显著差异,纤溶因子指标特别是D-二聚体在良恶性胸腔积液的鉴别诊断中有重要意义。Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （ PAI-1 ） in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion, t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ （52.49 ± 31.46） ng/mL and （58.12 ± 23.14） ng/mL vs （ 37.39 ± 22. 44 ） ng/mL, P 〈 0.05 ] , but was not statistically different between malignant pleural fluid and transudative （ P 〉 0. 05 ）. PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ （ 164. 86 ± 150. 22 ） ng/mL and （ 232.42 ± 175.77 ） ng/mL vs （46. 38 ± 16. 13 ） ng/mL, P 〈 0. 01 ], but was not statistically different between malignant and infectious pleural fluid（ P 〉 0. 05 ）. D-dimer levels in the three types of pleural fluid were significantly different, which was （23.66 ±25.18） mg/L, （6. 36 ± 10. 87） mg/L and （66. 90 ±42. 17） mg/L in malignant,transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was 〉 38.7 ng/mL （ area under ROC curve was 64.0 ） , with sensitivity of 60. 0% , specificity of 63.6%, positive predictive value of 66. 7%, negative predictive value of 56.8% and accuracy of 61.6%.The cutoff of D-dimer was 〈 27.0 mg/L （ area under ROC curve was 85.5 ）, with sensitivity of 84. 8%, specificity of 72.5% ,positive predictive value of 85.3%, negative predictive value of 71.8% and accuracy of 78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination （ t-PA ＋ D-dimer） were 92.5% , 60.6%, 74. 0%, 8

关 键 词：胸腔积液 纤溶因子 组织型纤溶酶原激活物 纤溶酶原激活物抑制剂-1 D-二聚体 鉴别诊断 

分 类 号：R446.6[医药卫生—诊断学]