胸水IL-27、ADA联合GeneXpert MTB/RIF对结核性胸膜炎的诊断价值  

The Diagnostic Value of Pleural Fluid IL-27 and ADA Combined withGeneXpert MTB/RIF in Tuberculous Pleurisy

作　　者：梁亚充 王国卫[2] 马丽 李晓倩 池跃朋[1] 王智慧[1] LIANG Yachong;WANG Guowei;MA Li;LI Xiaoqian;CHI Yuepeng;WANG Zhihui(Second Tuberculosis Department,Chest Hospital of Hebei Province,Shijiazhuang 050041,China;Traditional Chinese Medicine Department,Chest Hospital of Hebei Province,Shijiazhuang 050041,China;Endoscopy Room,Chest Hospital of Hebei Province,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院结核二科,河北石家庄050041 [2]河北省胸科医院中医科,河北石家庄050041 [3]河北省胸科医院内镜室,河北石家庄050041

出　　处：《标记免疫分析与临床》2022年第3期443-447,共5页Labeled Immunoassays and Clinical Medicine

基　　金：河北省医学科学研究课题计划项目(编号:20190995)。

摘　　要：目的探讨胸水白介素-27(IL-27)、腺苷脱氨酶(ADA)联合GeneXpert MTB/RIF对结核性胸膜炎的诊断价值。方法选取本院2019年1月至2021年1月住院的100例疑似结核性胸膜炎的患者作为研究对象,临床最终确诊结核性胸膜炎患者61例(结核性胸膜炎组)、非结核性胸膜炎患者39例(非结核性胸膜炎组)。采用酶联免疫吸附(ELISA)法检测胸水IL-27、ADA水平,同时对胸水标本行GeneXpert MTB/RIF检测;采用受试者工作特征曲线(ROC曲线)分析胸水IL-27、ADA对结核性胸膜炎的诊断价值;采用Kappa检验分析GeneXpert MTB/RIF单独检测及GeneXpert MTB/RIF、胸水IL-27、ADA三者联合检测与临床诊断的一致性。结果与非结核性胸膜炎组比较,结核性胸膜炎组胸水IL-27、ADA水平升高(P<0.05)。胸水IL-27、ADA水平诊断结核性胸膜炎的曲线下面积(AUC)分别为0.888、0.897,截断值分别为151.614ng/L、42.208U/L,特异性分别为84.6%、76.9%,灵敏度分别为82.0%、88.5%。GeneXpert MTB/RIF单独检测及GeneXpert MTB/RIF、胸水IL-27、ADA联合检测与临床诊断一致性分别为较高、极好(Kappa值=0.695、0.896,P<0.05)。与GeneXpert MTB/RIF、胸水IL-27、ADA联合检测比较,胸水IL-27、ADA水平单独检测诊断结核性胸膜炎的特异性、阳性预测值较低,误诊率较高(P<0.05)。结论在结核性胸膜炎诊断中,GeneXpert MTB/RIF联合胸水IL-27、ADA检测可进一步提高特异性和阳性预测值,降低误诊率,诊断更为准确。Objective To investigate the diagnostic value of pleural fluid interleukin-27(IL-27)and adenosine deaminase(ADA)combined with GeneXpert MTB/RIF in tuberculous pleurisy.Methods One hundred patients with suspected tuberculosis pleurisy who were hospitalized in our hospital from January,2019 to January,2021 were selected as the research objects,with 61 patients with tuberculous pleurisy(tuberculous pleurisy group)and 39 patients with non-tuberculous pleurisy(non-tuberculous pleurisy group)which was confirmed clinically.Enzyme-linked immunosorbent assay(ELISA)was applied to detect levels of IL-27 and ADA in pleural fluid,and GeneXpert MTB/RIF detection was performed on pleural fluid samples;Receiver operating characteristic curve(ROC curve)was drawn to analyze the diagnostic value of pleural fluid IL-27 and ADA for tuberculous pleurisy;Kappa test was used to analyze the consistency between GeneXpert MTB/RIF alone detection and combined detection of GeneXpert MTB/RIF,pleural fluid IL-27 and ADA with clinical diagnosis.Results Compared with the non-tuberculous pleurisy group,levels of IL-27 and ADA in the pleural fluid of the tuberculous pleurisy group increased(P<0.05).The area under the curve(AUC)of pleural fluid IL-27 and ADA levels in the diagnosis of tuberculous pleurisy were 0.888 and 0.897,respectively.With the cut-off value of 151.614 ng/L and 42.208 U/L,respectively,the specificity were 84.6%and 76.9%,and the sensitivity were 82.0%and 88.5%,respectively.The consistency of GeneXpert MTB/RIF alone detection and the combined detection of GeneXpert MTB/RIF,pleural fluid IL-27 and ADA with clinical diagnosis was better and excellent,respectively(Kappa value=0.695,0.896,P<0.05).Compared with the combined detection of GeneXpert MTB/RIF,pleural fluid IL-27 and ADA,the pleural effusion IL-27,ADA level alone detection for tuberculous pleurisy had a lower specificity,lower positive predictive value and higher misdiagnosis rate(P<0.05).Conclusion In the diagnosis of tuberculous pleurisy,GeneXpert MTB/RIF combined with ple

关 键 词：结核性胸膜炎 GeneXpert MTB/RIF 白介素-27 腺苷脱氨酶 诊断 

分 类 号：R561.1[医药卫生—呼吸系统]