结核性心包积液实验室诊断手段评价  

EVALUATION OF LABORATORY DIAGNOSTICS OF TUBERCULOUS PERICARDIAL EFFUSION

作　　者：吴艳华[1,2,3] 李霞[1] 

机构地区：[1]山东省医学科学院基础医学研究所山东省医药卫生肿瘤免疫与中药免疫重点实验室山东省罕少见病重点实验室卫生部生物技术药物重点实验室国家中医药管理局免疫药理(三级)实验室山东省免疫生物靶向药物工程技术中心,山东济南250062 [2]济南大学-山东省医学科学院医学与生命学院 [3]山东省胸科医院检验科

出　　处：《齐鲁医学杂志》2014年第5期442-444,447,共4页Medical Journal of Qilu

摘　　要：目的对结核性心包积液现有实验室诊断手段进行评价,以期提高实验室诊断效率。方法回顾性分析65例心包积液实验室检查结果,其中结核性心包积液20例,恶性心包积液30例,化脓性心包积液1例,原因不明心包积液9例,心脏疾病并发心包积液5例。评价抗酸染色、结核杆菌培养、荧光定量PCR、抗结核抗体、腺苷脱氨酶(ADA)、心包积液/血清ADA比值、心包积液/血清乳酸脱氢酶(LDH)比值、癌胚抗原(CEA)等诊断结核性心包积液的价值。结果抗酸染色、结核杆菌培养、荧光定量PCR三种方法,可对35%的结核性心包积液病人作出诊断。抗结核抗体检查灵敏度为92.9%,特异度为32.0%。心包积液/血清LDH比值>0.6虽可提示渗出液,但无助于结核性心包积液的诊断(P>0.05)。CEA对于区分结核性与恶性心包积液有较高临床价值,当心包积液CEA含量超过1.7μg/L时,可排除结核性心包积液的可能。结核性与非结核性心包积液组之间ADA的差异有显著意义(t′=2.629,P<0.05),但ADA的ROC曲线下面积为0.628,诊断价值较低。结核性与非结核性心包积液组之间心包积液/血清ADA比值的差异无显著意义(P>0.05)。结论诊断结核性心包积液,抗酸染色、结核杆菌培养、荧光定量PCR三种方法是必不可少的实验室检查;ADA可作为一种重要的辅助方法;CEA对区分恶性与结核性心包积液具有重要意义;而抗结核抗体、心包积液/血清ADA比值、心包积液/血清LDH比值对于结核性心包积液临床诊断无明显意义。Objective To evaluate and improve the available methods of laboratory diagnosis for tuberculous pericardial effusion（TPE）. Methods A retrospective analysis of laboratory diagnostic results was done in 65 cases of pericardial effusion（PE）,of which,20 were TPE,30 were malignant PE,one was purulant PE,nine were unknown-origin PE,and five PE due to heart disease.The diagnostic value of the following items was assessed：acid-fast stain,tubercle bacillus culture,fluorescent quantitation PCR,anti-TB-SA IgG,adenosine deaminase（ADA）,PE/serum LDH ratio,and carcinoembryonic antigen（CEA）. Results Acid-fast stain,tubercle bacillus culture and fluorescent quantitation PCR could be used to diagnose 35%of TPE.Anti-TBSA IgG test had a sensitivity of 92.9%,specificity of 32.0%.Though PE/serum LDH ratio0.6suggested effusion,there was helpless in the diagnosis of TPE.CEA had a high clinical value in the differential diagnosis of TPE and malignant PE,when the content of CEA in PE higher than 1.7μg/L,the possibility of TPE could be excluded.The difference of ADA between TPE and non-TPE groups was significant（t′=2.629,P〈0.05）,but when the area under ROC curve was 0.628,the diagnostic value of ADA was low.The difference of PE/serum ADA between TPE and non-TPE groups was not significant（P〉0.05）. Conclusion Acid-fast stain,tubercle bacillus culture,and fluorescent quantitation PCR are absolutely necessary in the diagnosis of tuberculous pericardial effusion.ADA can be used as an important auxiliary method,CEA is important in differential diagnosis of malignant PE and TPE.As for anti-TB-SA IgG,PE/Serum ADA ratio and PE/Serum LDH ratio have little significance in the diagnosis of tuberculous pericardial effusion.

关 键 词：结核 心包积液 实验室技术和方法 评价研究 

分 类 号：R446[医药卫生—诊断学] R52[医药卫生—临床医学]