胸水中D-dimer浓度与胸膜组织病理学检查对结核性胸膜炎的诊断价值  

Diagnostic Value of Hydrothorax D-Dimer Concentration Test and Pleura Histopathology on Diagnosing Tuberculous Pleurisy

作　　者：张艳丽 武丽[1] 李翠茹 

机构地区：[1]保定市传染病医院,河北保定071000 [2]邯郸市传染病医院,河北邯郸056000

出　　处：《贵州医科大学学报》2017年第12期1439-1442,共4页Journal of Guizhou Medical University

基　　金：保定市科技计划项目(17ZF080)

摘　　要：目的:探讨胸水中D-dimer水平检测与胸膜组织病理学检查(CNPB)两种方法对结核性胸膜炎的诊断价值。方法:收集110例结核性胸膜炎及121例非结核性胸膜炎患者的胸水,采用Beckman高效液相色谱仪、干式免疫散射色谱法检测胸水中D-dimer浓度;同时用Cope针采集胸膜标本常规苏木素-伊红染色,以检出肉芽肿性病变确诊结核性胸膜炎;以D-dimer浓度阈值制作受试者操作曲线(ROC),比较两种检查方法对结核性胸膜炎诊断的灵敏度、特异度、预测值和准确度,以ROC曲线下面积(AUC)>0.5认为具有诊断价值。结果:结核性胸水中D-dimer浓度高于非结核性胸腔积液,差异具有统计学意义(P<0.05);对于结核性胸膜炎的诊断,Ddimer敏感性明显高于CNPB(P<0.05),D-dimer的特异性、阳性预测值明显低于CNPB(P<0.05);D-dimer的ROC曲线中AUC值虽然高于CNPB的AUC值,但是不具有统计学意义(P>0.05);D-dimer对结核性胸膜炎诊断的最佳截断值为≥283.21 mg/L。结论:D-dimer检测是一种准确率较高的结核性胸膜炎的诊断方法,可以辅助结核性胸膜炎的诊断。Objective： To compare the diagnostic value of hydrothorax D-dimer concentration test and pleura histopathology on diagnosing tuberculous pleurisy. Methods： Collecting hydrothorax of 110 tuberculous pleurisy cases and 121 non-tuberculous pleurisy,adopting Beckman HPLC,Dry Immune Scattered Chromatography to detect concentration level of D-dimer in hydrothorax; meanwhile,adopting Cope needle to collect regular hematoxylin and eosin stain in pleural specimens in order to detect the granulomatous lesion to diagnose tuberculous pleurisy. Creating ROC on D-dimer concentration threshold value,comparing sensitivity,specificity,predictive value and accuracy of diagnosing tuberculous pleurisy from both assays; ROC AUC 0. 5 is considered with diagnostic value. Results： Tuberculous pleurisy hydrothorax D-dimer concentration is higher than non-tuberculous pleurisy hydrothorax,difference was statistically significant（ P〈0. 05）. Concerning diagnosing tuberculous pleurisy,D-dimer sensitivity was obviously higher than CNPB（ P〈0. 05）; while specificity,positive predictive value was obviously lower than CNPB（ P〈0. 05）; AUC value of ROC curve of D-dimer was higher than that of CNPB,but it showed no statistical significance（ P〈0. 05）; the best cutoff value of D-dimer on diagnosing tuberculous pleurisy was≥283. 21 mg/L. Conclusion： D-dimer assay could serve as a better way of diagnosing tuberculous pleurisy

关 键 词：胸膜炎 结核 诊断 D二聚体 活组织检查 病理学 

分 类 号：R521[医药卫生—内科学]