腺苷脱氨酶及IL-22对结核性胸膜炎诊断价值的探究  

Diagnostic value of adenosine deaminase and IL-22 in tuberculous pleurisy

作　　者：李翔云 李峥[1] 张泽明 刘丽君[1] Li Xiangyun;Li Zheng;Zhang Zeming;Liu Lijun(Department of Respiratory Medicine,the Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Respiratory Medicine,Shanghai Pudong New District Zhoupu Hospital,Shanghai 201318,China)

机构地区：[1]河北大学附属医院呼吸内科,保定071000 [2]上海浦东新区周浦医院呼吸内科,201318

出　　处：《国际呼吸杂志》2020年第8期604-607,共4页International Journal of Respiration

摘　　要：目的探讨胸腔积液中腺苷脱氨酶(ADA)和白细胞介素22(IL-22)检测对结核性胸膜炎(TPE)的诊断价值.方法对2015年10月至2017年8月在河北大学附属医院呼吸内科住院的108例胸腔积液患者的临床资料进行分析,最终有104例患者经内科胸腔镜确诊,其中TPE患者38例,恶性胸腔积液患者40例,类肺炎性胸腔积液患者26例;对胸腔积液中ADA和IL-22水平进行统计分析.结果(1)108例患者经胸腔镜直视下取病理活检的诊断率为96.3%(104/108).(2)TPE组中ADA和IL-22水平均显著高于恶性胸腔积液组和类肺炎性胸腔积液组,差异均有统计学意义(P值均<0.05);胸腔积液中ADA和IL-22诊断TPE的敏感度和特异度分别为92.1%和87.9%,78.9%和90.9%.(3)受试者工作特征曲线结果显示,胸腔积液ADA和IL-22诊断TPE的曲线下面积分别为0.904和0.914,最佳诊断阈值分别为34.4 U/L和44.28 ng/L.(4)两者平行试验的敏感度和特异度分别为98.3%、79.9%,敏感度较单独检测提高;系列试验的敏感度和特异度分别为72.2%、98.9%,特异度较单独检测提高.结论(1)内科胸腔镜是一项操作简便、创伤小、并发症少的操作方法,可作为TPE的早期诊断与鉴别诊断;(2)胸腔积液ADA和IL-22水平对诊断TPE具有一定价值,可作为临床辅助诊断TPE的实验室指标;(3)ADA和IL-22联合检测可提高TPE的诊断率.Objective To discuss the value of adenosine deaminase(ADA)and interleukin-22(IL-22)in diagnosis of tuberculous pleurisy(TPE).Methods The clinical data of 108 patients with pleural effusion admitted to the respiratory department of Affiliated Hospital of Hebei University from October 2015 to August 2017 were analyzed,finally,104 patients were diagnosed by medical thoracoscopy,including 38 patients with TPE,40 patients with malignant pleural effusion,26 patients with pneumonia like pleural effusion,analyzed the result of ADA.The levels of ADA and IL-22 in pleural effusion were statistically analyzed.Results(l)The diagnostic rate of biopsy by thoracoscopic direct vision in 108 patients was 96.3%(104/l08).(2)The levels of ADA and IL-22 in tuberculosis group were significantly higher than those of in malignant and inflammatory groups(P<0.05).The sensitivity and specificity of pleural fluid ADA and IL-22 in diagnosing TPE were 92.1% and 87.9%,78.9% and 90.9%.(3)The receiver operating characteristic curve results showed that the area under the curve of TPE diagnosed by pleural fluid ADA and IL-22 were 0.904 and 0.914 respectively,and the best diagnostic thresholds were 34.4 U/L and 44.28 ng/L.(4)The sensitivity and specificity of the parallel test were 98.3% and 79.9%respectively,and the sensitivity was higher than that of the separate test.The sensitivity and specificity of the series test were 72.2% and 98.9%,respectively,and the specificity was higher than that of the separate test.Conclusions(1)Medical thoracoscopy is a simple,less traumatic,less complications of the operation method,can be used as early diagnosis and differential diagnosis of TPE.(2)Pleural effusion ADA and IL-22 levels have some value in the diagnosis of TPE,TPE can be used as clinical laboratory diagnostic laboratory parameters.(3)Combined detection of ADA and IL-22 can improve the diagnostic rate of TPE.

关 键 词：胸腔镜检查 腺苷脱氨酶 结核 胸膜 白细胞介素22 

分 类 号：R5[医药卫生—内科学]