胸腔积液ADA,PTP联合PTP/STP比值提高结核性胸膜炎的检出率  

Elevation of the diagnostic rate of tuberculous pleural effusion

作　　者：张继华[1] 张丽琼[1] 蒋云燕[1] 李晓[1] 姜华[1] 

机构地区：[1]昆明医科大学第六附属医院玉溪市人民医院呼吸内科,云南玉溪653100

出　　处：《云南医药》2016年第2期141-144,共4页Medicine and Pharmacy of Yunnan

基　　金：云南省科技厅-昆明医科大学联合专项基金资助项目(2014FZ049)

摘　　要：目的评估胸腔积液及血清中相关指标对结核性及恶性胸腔积液的鉴别诊断价值,提高结核性胸腔积液的诊断率。方法 98例胸腔积液患者,其中49例经组织病理学或病原学明确诊断为结核性胸腔积液,49例诊断为恶性胸腔积液。检测全部患者胸腔积液中腺苷脱氨酶(ADA),总蛋白(PTP),乳酸脱氢酶(LDH),淋巴细胞比例(L%),对应血清中总蛋白(STP),ESR,经统计学处理后,分别评价各项指标对结核性与恶性胸腔积液的鉴别诊断价值,并判定胸液ADA活性,PTP,PTP/STP比值诊断结核性胸液的灵敏度,特异度及临床诊断率。结果结核性与恶性胸腔积液之间,胸液ADA活性,PTP,PT P/STP比值间差异有显著统计学意义(P<0.01),ESR,淋巴细胞所占比例差异无统计学意义(P>0.05)。利用ROC曲线,确定ADA,PPT,PTP/STP比值诊断结核性胸腔积液的最佳临界值分别为24.4U/L,0.72和48.5g/L。结论ADA,PTP,PTP/STP对结核性胸腔积液的鉴别诊断具有重要意义,联合3项指标可增加结核性胸腔积液的临床检出率,若患者年龄<65岁,则临床诊断准确率更高。Objective To investigate the differential diagnostic value of tuberculous pleural effusion from malignant pleural effusion by different indicators in serum and pleural effusion, and improve the diagnosis of tuberculous pleural effusion. Methods 98 patients with pleural effusion were involved, including 49 cases with tuberculous pleural effusion and 49 cases with malignant pleural effusion. The levels of ADA,PTP,LDH,percentage of lymphocyte in pleural effusion,and STP,ESR in serum were determined. Then to evaluate the differential diagnosis value of each index in tuberculous and malignant pleural effusion, as well as its diagnostic sensitivity,specificity and clinical diagnosis rates. Results The levels of ADA,PTP,PTP/STP in tuberculous effusion were higher than those in malignant effusion（P〈0.01）,but there was no statistically significant in ESR and percentage of lymphocyte（P〉0.05）.ROC curve was used to determine the best critical value of ADA, PTP, PTP/STP ratio.In the diagnosis of tuberculous pleural effusion,those were 24.4 U/L, 48.5 g/L and 0.72 respectively. Conclusion ADA,PTP,PTP/STP can be used as valuable parameters for the differentiation of tuberculous effusion from malignant effusion.When combining the three indicators, it can increase the clinical detection of tuberculous pleural effusion. If the patient’ age is less then 65 years old, the clinical diagnostic accuracy can be higher.

关 键 词：腺苷脱氨酶 总蛋白 结核性胸膜炎 鉴别诊断 

分 类 号：R521.7[医药卫生—内科学]