结核性胸腔积液患者胸水腺苷脱氨酶的影响因素分析及最佳界值的制定  

Factors affecting pleural fluid ADA and the optimal ADA levels for diagnosis of tuberculous pleural effusion

作　　者：任增花 徐凌[1] REN Zenghua;XU Ling(Department of Respiratory Medicine,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院呼吸内科

出　　处：《实用医学杂志》2019年第19期3075-3080,共6页The Journal of Practical Medicine

摘　　要：目的探讨影响结核性胸腔积液(tuberculous pleural effusion,TPE)腺苷脱氨酶(adenosine deaminase,ADA)水平的因素,并制定诊断TPE的最佳ADA界值。方法对2003年1月至2018年8月在上海交通大学附属第六人民医院住院治疗的443例胸腔积液患者的相关临床与实验室检查资料进行回顾性分析,其中包括192例TPE,54例肺炎旁胸腔积液(parapneumonic pleural effusion,PPE)和197例恶性胸腔积液(malignant pleural effusion,MPE)。采用多元Logistic回归分析探讨影响TPE患者ADA水平的独立因素。以50岁为界将研究人群分为两组(≤50岁和>50岁组)。应用受试者工作特征(receiver operating characteristic,ROC)曲线制定诊断TPE的最佳ADA界值。结果年龄和胸水中性粒细胞百分比是影响TPE患者ADA水平的独立因素,尤其是年龄。胸水ADA水平在≤50岁组显著高于>50岁组(P<0.001)。两个年龄组中,胸水ADA诊断TPE的最佳临界值分别为17.5和9.5 U/L,灵敏度和特异度分别为94.4%、80.5%和94.1%、67.1%。结论年龄是影响TPE患者胸水ADA水平的重要因素,对于年龄较大患者,使用较低的ADA界值诊断TPE可减少假阴性。Objective To evaluate factors affecting pleural fluid adenosine deaminase(ADA)levels in tuberculous pleural effusion(TPE),and to determine the best cut off value of ADA for diagnosis of TPE.Methods A retrospective analysis of the clinical and laboratory data was conducted on 443 patients with pleural effusion hospitalized in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from January 2003 to August 2018,including 192 TPE,54 parapneumonic pleural effusion(PPE),and 197 malignant pleural effusion(MPE).Multi variate logistic regression analysis was used to explore the independent factors affecting ADA levels in TPE patients.The study population was divided into two groups by the age of 50(≤50 years old group and>50 years old group).The best cut off value of ADA for diagnosing TPE was determined by receiver operating characteristic(ROC)curve.Results Age and percentage of neutrophils in pleural fluid were independent factors affecting ADA levels in TPE patients,especially age.The pleural fluid ADA level was significantly higher in≤50 years old group than that in>50 years old group(P<0.001).The best cut off values of pleural fluid ADA for the diagnosis of TPE in the two age groups were 17.5 U/L and 9.5 U/L,respectively,with sensitivity of 94.4%,80.5%,respectively,and specificity of 94.1%,67.1%,respectively.Conclusion Age is an important factor affecting pleural fluid ADA in TPE patients.For older people,using a lower ADA cut off value to diagnose TPE can reduce false negative.

关 键 词：结核 胸腔积液 腺苷脱氨酶 影响因素 临界值 诊断效能 

分 类 号：TQ3[化学工程]