多项指标筛选鉴别诊断恶性与结核性胸腹水诊断价值  

Screening and Differential Diagnosis Between Malignant and Tuberculous Pleural Effusion or Ascites by Many Index

作　　者：黄胜[1] 周丹[1] 余继英[1] 邹刚[1] 黄连贵[1] 

机构地区：[1]松滋市人民医院内科,湖北松滋434200

出　　处：《湖北民族学院学报（医学版）》2012年第2期14-16,共3页Journal of Hubei Minzu University(Medical Edition)

摘　　要：目的筛选适合基层医院用于鉴别恶性与结核性胸腹水诊断价值相对较高的检验指标。方法 117份胸腹水标本分为恶性组39例与结核组78例,选择胸腹水腺苷脱氨酶(ADA)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、胆固醇(CHO)、葡萄糖(GLU)、β2微球蛋白(β2m)和血小板计数(BPC)作为观察指标。结果ADA、CEA、CRP和BPC 4项在恶性组与结核组之间存在显著性差异;分析上述4项指标分别对恶性及结核性胸腹水诊断的灵敏度、特异度、符合率、阳性预测值和约登指数,显示对恶性和结核性胸腹水诊断价值高低顺序均是CEA>ADA>BPC>CRP;联合指标筛查以CEA和ADA联合诊断价值最高,优于单项检验指标,尤其是对于恶性胸腹水的诊断。结论 ADA、CEA、CRP和BPC 4项对恶性与结核胸腹水鉴别诊断有较大参考价值,联合检测胸腹水ADA和CEA可明显提高诊断价值。Objective To screen for relatively high index of the inspection diagnostic value which is suitable for local hospital to identify malignant and tuberculosis pleural fluid or ascites.Methods 117 pleural fluid or ascites samples were divided into malignant group（39 cases） and tuberculosis group（78 cases）,and ammonia enzyme（ADA）,cancer embryos antigen（CEA）,lactate dehydrogenase（LDH）,C-reactive protein（CRP）,cholesterol（CHO）,glucose（GLU）,β2micro globulin（β2m） and blood platelet count（BPC） of pleural fluid or ascites were chosen as the indicators.Results There were significant differences in ADA,CEA,CRP and BPC between malignant group and tuberculosis group.The analyses of the specific degrees,sensitivity,crude agreement,positive predictive value and Youden′s index of the four indicators above in malignant group and tuberculosis pleural fluid or ascites showed the diagnostic value from high to low order was CEA〉ADA〉BPC〉CRP.In joint index of screening,the combination diagnostic value of CEA and ADA was better than that of single test index,especially for the diagnosis of malignant pleural fluid or ascites.Conclusion ADA、CEA、CRP and BPC have high reference value in the differential diagnosis between malignant and tuberculosis pleural fluid or ascites,and united detection of ADA and CEA can obviously increase diagnosis value.

关 键 词：结核性胸腹水 恶性胸腹水 腺苷脱氨酶 癌胚抗原 鉴别诊断 

分 类 号：R446.6[医药卫生—诊断学] R446.1[医药卫生—临床医学]