多种抗结核分支杆菌抗体和胸膜活检对结核性胸膜炎诊断价值  

Value of testing of a variety of antibodies against Mycobacterium tuberculosis and pleural biopsy for diagnosis of tuberculous pleurisy

作　　者：赵剑平[1] 孔文琴[1] 常占平[1] 朱新颖[1] 

机构地区：[1]北京胸科医院,北京100095

出　　处：《中国防痨杂志》2002年第4期188-191,共4页Chinese Journal of Antituberculosis

摘　　要：目的　探讨多种抗结核分支杆菌抗体和胸膜活检术对结核性胸膜炎诊断价值。方法　对1 2 1例结核性胸膜炎 (合并肺结核 60例) ,44例癌性胸液患者进行血清、胸液四项抗结核抗体测定 (抗PPD -IgG、LAM -IgG卡、TB -Dot卡、ICT -TB卡 ) ,对 72例结核性胸膜炎病人进行胸膜活检病理检查。结果　血清四项抗体检测结核组阳性率分别为 75 .6%、3 0 .7%、44.7%、3 5 .1 % ;癌性组为43 .2 %、1 7.1 %、1 1 .4%、2 .6%。胸液四项抗体检测结核组阳性率分别为 81 .7%、2 4.0 %、2 7.1 %、2 2 .7% ;癌性组为 5 1 .2 %、1 4.7%、5 .9%、2 .8%。血清和胸液结核组均比癌性组高 ,合并肺结核高于单纯性胸膜炎组。敏感性以抗PPD -IgG为最高 ,但特异性差 (血清 5 6.8% ,胸液 48.8% ) ,与癌性胸水存在明显交叉 ;LAM -IgG卡、TB -Dot卡、ICT -TB卡 ,特异性血清分别为 82 .9%、88.6%、97.4% ,胸液为 85 .3 %、94.1 %、97.2 % ,比抗PPD -IgG高 ,但敏感性较低。胸液抗体检测阳性率除抗PPD -IgG外略低于血清。以抗PPD -IgG加TB -Dot卡 (A组 )或抗PPD -IgG与ICT -TB卡 (B组 )两项阳性组合 ,且两项均阳性时 ,特异性 ,血清可达 94.3 %～ 1 0 0 % ,胸液可达 91 .4%～ 97.2 %。阳性率 ,血清为 43 .0 %～ 42 .98% ,胸液为 2 3 .7%～ 1 7.2 %Objective To probe value of testing of a variety of antibodies against Mycobacterium tuberculosis and pleural biopsy in diagnosis of tuberculous pleurisy.Methods 121 cases of tuberculous pleurisy (60 of them had also been with pulmonary tuberculosis) and 44 cases of carcinomatous pleurisy were subject to testing of antibodies (PPD-lgG, LAM-IgG Card, TB Dot Card, ICT-TB Card) against Mycobacterium tuberculosis in both serum and chest fluid, while 72 cases of tuberculous pleurisy were subject to pathological examination of pleural biopsy.Results Positive rates of 4 antibodies in serum was 75.6%, 30.7%,44.7% and 35.1% respectively, while counterparts in carcinomatous pleurisy was 43.2%, 17.1%,11.4% and 2.6% respectively. Positive rates of 4 antibodies in chest fluid was 81.7%,24.0%,27.1% and 22.7%, while counterparts in carcinomatous pleurisy was 51.2%,14.7%, 5.9% and 2.8%. Positive rates registered in both serum and chest fluid were higher than that of in carcinomatous pleurisy, positive rates of those tuberculous pleurisy with pulmonary tuberculosis were higher than that of in simple tuberculous pleurisy. PPD-lgG had the highest sensitivity but had the least specificity (56.8% in serum and 48.8% in chest fluid) and had obvious cross with carcinomatous chest fluid; as for LAM-lgG Card, TB-Dot Card, ICT-TB Card, specificity in serum was 82.9%, 88.6% and 97.4% respectively and specificity in chest fluid was 85.3%, 94.1% and 97.2% repectively, they had higher specificity than PPD-lgG but had lower sensitivity than PPD-lgG. Except for PPD-lgG, positive rates of antibodies in chest fluid were all slightly lower than that of in serum. If two positive rates were combined together as set A: PPD-lgG and TB-Dot Card or set B: PPD-lgG and ICT-TB Card, specificity of diagnosis by positive rates from serum could achieve to 94.3%～100% and specificity of diagnosis by positive rates from chest fluid could achieve to 91.4%～97.2%. Combined positive rate in serum was 36%～42.98% and in chest fluid was 17%～

关 键 词：抗结核分支杆菌抗体 胸膜活检 结核性胸膜炎 诊断 

分 类 号：R521.7[医药卫生—内科学]