胸腔积液总蛋白、腺苷脱氨酶以及肿瘤标志物检测对结核性和恶性胸腔积液诊断价值分析  

Diagnostic value of the determination of total protein,adenosine deaminase and tumor markers to tuberculous and malignant pleural effusion

作　　者：薛聃[1] 周燕斌[2] 曾显声[2] 黄茂宏[2] 

机构地区：[1]福建医科大学附属协和医院呼吸内科,福州市350001 [2]中山大学附属第一医院呼吸内科,广州市510080

出　　处：《中华实用诊断与治疗杂志》2010年第12期1158-1161,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广东省自然科学基金资助项目(06300788)

摘　　要：目的:探讨胸腔积液总蛋白、腺苷脱氨酶、癌胚抗原、细胞角蛋白19片断、神经元特异性烯醇化酶对结核性和恶性胸腔积液的诊断价值。方法:检测恶性胸腔积液患者20例、结核性胸膜炎患者30例、非结核性良性胸腔积液患者20例的胸腔积液总蛋白,同时用化学酶法检测腺苷脱氨酶,电化学发光法检测癌胚抗原、细胞角蛋白19片断、神经元特异性烯醇化酶水平。结果:以胸腔积液腺苷脱氨酶>40 u/L、总蛋白>45 g/L为临界值,对诊断结核性胸腔积液的灵敏度分别为60.0%(18/30)和100.0%(30/30),特异度分别为100.0%(40/40)和82.5%(33/40),Youden指数分别为0.6和0.83,准确度分别为82.9%(58/70)和90.0%(63/70)。以癌胚抗原>10 ng/mL、细胞角蛋白19片断>15.5 ng/mL和神经元特异性烯醇化酶>16 ng/mL为临界值,诊断恶性胸腔积液的灵敏度分别为95.0%(19/20)、80.0%(16/20)和55.0%(11/20),特异度分别为100.0%(50/50)、72.0%(36/50)和92.0%(46/50),Youden指数分别为0.95、0.52和0.47,准确度分别为98.6%(69/70)、74.3%(52/70)和81.4%(57/70)。结论:胸腔积液总蛋白、腺苷脱氨酶、癌胚抗原、细胞角蛋白19片断、神经元特异性烯醇化酶对结核性和恶性胸腔积液具有诊断及鉴别诊断价值。Objective To investigate the diagnostic value of total protein,adenosine deaminase,carcinoembryonic antigen,CYFRA21-1 and neuron-specific enolase on tuberculous and malignant pleural effusion.Methods A total of 20 cases of malignant pleural effusion,30 cases of tuberculous pleuritis and 20 cases of effusion pleuritis without tuberculosis were determined total protein with automatic clinical chemistry analyzer,adenosine deaminase with chemical enzymer,and carcinoembryonic antigen,CYFRA21-1 and neuron-specific enolase with electrochemiluminescence immune assay.Results In patients with tuberculous pleuritis,the sensitivities of adenosine deaminase（40 u/L） and total protein（45 g/L） were 60.0%（18/30） and 100.0%（30/30） respectively,and the specificities were 100.0%（40/40） and 82.5%（33/40） respectively,Youden indexes were 0.6 and 0.83 respectively,and the diagnosis accordance rates were 82.9%（58/70） and 90.0%（63/70） respectively.In patients with malignant pleural effusion,the sensitivities of carcinoembryonic antigen（10 ng/mL）,CYFRA21-1（15.5 ng/mL） and neuron-specific enolase（16 ng/mL） were 95.0%（19/20）,80.0%（16/20）and 55.0%（11/20） respectively,the specificities were 100.0%（50/50）,72.0%（36/50） and 92.0%（46/50） respectively,and Youden indexes were 0.95,0.52 and 0.47 respectively,and diagnosis accordance rates were 98.6%（69/70）,74.3%（52/70） and 81.4%（57/70）.Conclusion The determination of total protein,adenosine deaminase,carcinoembryonic antigen,CYFRA21-1 and neuron-specific enolase in pleural fluids is of great value in differentiating tuberculous pleuritis from malignant pleural effusion.

关 键 词：胸腔积液 腺苷脱氨酶 肿瘤标志物 

分 类 号：R521.7[医药卫生—内科学] R730.4[医药卫生—临床医学]