胸水ADA和TB-DNA联合检测对结核性胸腔积液的诊断  

Combined detection of adenosine deaminase and mycobacterium tuberculosis DNA in hydrothorax for the diagnosis of tuberculous pleural effusion

作　　者：周晓宇[1] 李伟[1] 陈余清[1] ZHOU Xiao-yu;LI Wei;CHEN Yu-qing(Department of Pulmonary Critical Care Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科,安徽蚌埠233000

出　　处：《中国临床研究》2018年第8期1098-1101,共4页Chinese Journal of Clinical Research

基　　金：国家自然科学基金项目(81172213);安徽省自然科学基金项目(1408085MH144);蚌埠医学院自然科学基金项目(BYKT1674)

摘　　要：目的探讨胸水中腺苷脱氢酶(ADA)、结核分枝杆菌(TB)DNA的联合检测对结核性胸腔积液的诊断价值。方法采集2015年1月至2018年1月入住蚌埠医学院第一附属医院呼吸科的102例胸腔积液患者的胸水标本,运用全自动生化分析仪测定ADA,以ADA>40 U/L为阳性;全自动荧光定量检测TB-DNA,将TB-DNA>500拷贝作为阳性标准。比较胸水ADA、TB-DNA单一检测和联合检测的诊断效能。结果 ADA检测结果的Kappa=0.782,TB-DNA检测结果的Kappa=0.165,ADA+TB-DNA检测结果的Kappa=0.822,提示ADA+TB-DNA联合诊断一致性最好,且与最终诊断符合程度较高。ADA+TB-DNA联合诊断灵敏度为91.3%,特异度为91.1%,准确度为91.2%。结核性胸腔积液与恶性胸腔积液患者性别比较无统计学差异(P>0.05);结核性胸腔积液患者ADA值显著高于恶性胸腔积液患者,年龄显著低于恶性胸腔积液患者(P均<0.01)。结论胸水中ADA、TB-DNA的联合检测有助于结核性胸腔积液的诊断。Objective To investigate the diagnosis value of combined detection of adenosine deaminase（ADA） and mycobacterium tuberculosis（TB） DNA in hydrothorax for the diagnosis of tuberculous pleural effusion. Methods The samples of 102 patients with pleural effusion who received treatment at The First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2018 were collected. Full-automatic biochemical analyzer was used to detected ADA（ADA〉40 U/L as a positive standard） and real-time fluorescent quantitative PCR was used to detect TB-DNA（TB-DNA〉500 copy as a positive standard）. The diagnostic efficiency were compared with single and combined detection of ADA and TB-DNA in pleural fluid. Results The diagnostic agreement result of ADA,TB-DNA and ADA plus TB-DNA was Kappa = 0. 782,Kappa = 0. 165,Kappa = 0. 882 respectively,which showed that ADA combined with TB-DNA had best diagnostic agreement and it had a good compliance degree with the final diagnosis. The sensitivity,specificity and accuracy of ADA and TB-DNA combined detection was 91. 3%,91. 1% and 91. 2% respectively. There was no significant difference in gender between tuberculous pleural effusion patients and malignant pleural effusion patients（P〉0. 05）. Compared with malignant pleural effusion patients,tuberculous pleural effusion patients had a higher ADA value and lower age（all P〈0. 01）. Conclusion The combined detection of ADA and TB-DNA in pleural fluid is helpful to the diagnosis of tuberculous pleural effusion.

关 键 词：腺苷脱氢酶 结核分枝杆菌DNA 结核性胸腔积液 联合诊断 敏感性 特异性 

分 类 号：R521.7[医药卫生—内科学]