腺苷脱氨酶、γ-干扰素和γ-干扰素诱导蛋白10对结核性胸膜炎的诊断作用研究  

The value of adenosine deaminase, interferon-gamma, and interferon-gamma induced protein of 10kD in the diagnosis of tuberculous pleuritis

作　　者：董雅坤[1] 栗爱珍[1] 郑立恒[2] 池跃朋[1] 王玉红[1] 王秋梅[1] 朱桂云[1] 谢兰品[1] 

机构地区：[1]河北省胸科医院结核科,石家庄050041 [2]河北省胸科医院检验科,石家庄050041

出　　处：《解放军医学杂志》2015年第6期458-462,共5页Medical Journal of Chinese People's Liberation Army

基　　金：2014年政府资助省级临床医学优秀人才培养项目(2014571029)~~

摘　　要：目的探讨胸腔积液中腺苷脱氨酶(ADA)、γ-干扰素(IFN-γ)和γ-干扰素诱导蛋白10(IP-10)水平对结核性胸膜炎的诊断价值。方法检测63例结核性胸膜炎及50例恶性胸腔积液患者胸腔积液中ADA、IFN-γ和IP-10的含量,经统计学分析,评价其对结核性胸膜炎的诊断价值。结果结核性胸腔积液中ADA、IFN-γ和IP-10含量明显高于恶性胸腔积液,差异有统计学意义(P<0.01)。ADA(以45U/L为临界值)诊断结核性胸膜炎的敏感度为71.4%,特异度为94.0%,诊断比值比39.17;IFN-γ(以138.5pg/ml为临界值)诊断结核性胸膜炎的敏感度为93.7%,特异度为82.0%,诊断比值比67.19;IP-10(以9.21μg/ml为临界值)诊断结核性胸膜炎的敏感度为85.7%,特异度为90.0%,诊断比值比54.00。3项指标联合检测时任何2项阳性诊断结核性胸膜炎的敏感度为95.2%,特异度为96.0%,诊断比值比72.16。结论联合检测ADA、IFN-γ和IP-10可提高结核性胸膜炎的诊断效能。Objective To explore the value of adenosine deaminase（ADA） activity, interferon-gamma（IFN-γ） and IFN-γinduced protein of 10 k D（IP-10） levels in pleural effusion for the diagnosis of tuberculous pleuritis. Methods ADA activity, IFN-γand IP-10 levels in pleural effusion were determined in sixty-three patients with tuberculous pleuritis and 50 patients with malignant pleural effusion. Results The mean levels of ADA, IFN-γ and IP-10 in the tuberculous pleural effusion were significantly higher than those in malignant pleural effusion（P〈0.01）. W hen 45U/L was regarded as cut off value for ADA, the sensitivity, specificity and diagnostic odds ratio in the diagnosis of tuberculous pleurisy were 71.4%, 94.0% and 39.17 respectively. W hen 138.5pg/ml was regarded as cut off value for IFN-γ in tuberculous pleural effusion, the sensitivity, specificity and diagnostic odds ratio were 93.7%, 82.0% and 67.19 respectively. W hen 9.21μg/ml was regarded as cut off value for IP-10 in tuberculous pleural effusion, the sensitivity, specificity and diagnostic odds ratio were 85.7%, 90.0% and 54.00 respectively. The combined determination of the three markers for the diagnosis of tuberculous pleurisy had a sensitivity of 95.2%, specificity of 96.0% and diagnostic odds ratio of 72.16. Conclusion The accuracy of diagnosis for tuberculous pleurisy can be improved by combined determination of ADA, IFN-γ and IP-10.

关 键 词：分枝杆菌 结核 胸腔积液 恶性 腺苷脱氨酶 干扰素Γ 重组 

分 类 号：R521.7[医药卫生—内科学]