结核、肺癌性胸膜炎患者胸腔积液内IL-27、TNF-α、CA15-3及VEGF水平比较  

Comparison of IL-27,TNF-α,CA15-3 and VEGF levels in pleural effusion of patients with tuberculosis and lung cancer pleurisy

作　　者：白峰[1] 张小雷 杨剑飞 王明正[1] 李倩倩 BAI Feng;ZHANG Xiao-lei;YANG Jian-fei(Department of Thoracic Surgery,Hebei Provincial Chest Hospital,Shijiazhuang Hebei 050041,China;Department of General Internal Medicine,the Eighth People's Hospital of Hebei Province,Shijiazhuang Hebei 050000,China;Department of Surgical,Zhengding County People's Hospital,Shijiazhuang Hebei 050800,China)

机构地区：[1]河北省胸科医院胸外科,河北石家庄050041 [2]河北省第八人民医院普内科,河北石家庄050000 [3]正定县人民医院外科,河北石家庄050800

出　　处：《临床和实验医学杂志》2022年第14期1516-1519,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究重点课题计划(编号:20180651)。

摘　　要：目的探讨胸腔积液内白细胞介素27(IL-27)、肿瘤坏死因子α(TNF-α)、糖类抗原15-3(CA15-3)及血管内皮生长因子(VEGF)在结核、肺癌性胸膜炎鉴别中的价值。方法回顾性选取2018年3月至2021年3月在河北省胸科医院就诊的100例因胸腔积液患者,根据细胞学检验结果分为结核性胸膜炎组62例与肺癌性胸膜炎组38例。比较两组均检测胸腔积液内IL-27、TNF-α、CA15-3及VEGF水平,在受试者工作特征(ROC)曲线的辅助下明确胸腔积液内IL-27、TNF-α、CA15-3及VEGF诊断肺癌性胸膜炎的价值,最后通过一致性分析胸腔积液内IL-27、TNF-α、CA15-3及VEGF联合诊断肺癌性胸膜炎的效能。结果结核性胸膜炎组患者的IL-27水平为(504.74±113.25)ng/L,显著高于肺癌性胸膜炎组[(504.74±113.25)ng/L],TNF-α、CA15-3及VEGF水平为(47.31±21.48)pg/L、(21.33±9.01)KU/L、(145.31±73.94)pg/L,显著低于肺癌性胸膜炎组[(94.98±57.74)pg/L、(64.71±21.48)KU/L、(419.33±101.46)pg/L],差异均有统计学意义(P<0.05)。经ROC分析证实,胸腔积液IL-27、TNF-α、CA15-3及VEGF均能用于肺癌性胸膜炎的诊断,曲线下面积分别为0.935、0.840、0.949、0.934;联合诊断中以胸腔积液IL-27≤402.920 ng/L、TNF-α≥69.188 pg/L、CA15-3≥54.082 KU/L、VEGF≥192.705 pg/L为阳性,任一指标为阳性则判定为联合诊断阳性。经一致性分析证实,联合诊断中阳性32例,敏感度为84.2%,特异度为96.8%,准确率为92.0%,阳性预测值为0.941,阴性预测值为0.910,Kappa=0.827。结论结核、肺癌性胸膜炎患者胸腔积液内IL-27、TNF-α、CA15-3及VEGF均存在明显差异,且通过ROC分析、一致性分析均证实IL-27、TNF-α、CA15-3及VEGF联合应用于结核、肺癌性胸膜炎的鉴别具有更高的价值。Objective To investigate the value of interleukin 27(IL-27),tumor necrosis factorα(TNF-α),carbohydrate antigen 15-3(CA15-3)and vascular endothelial growth factor(VEGF)in pleural effusion in the differentiation of tuberculosis and lung cancer pleurisy.Methods A total of 100 patients with pleural effusion admitted to Hebei Provincial Chest Hospital from March 2018 to March 2021 were retrospectively selected and divided into 62 cases of tuberculous pleurisy group and 38 cases of lung cancer pleurisy group according to cytological examination results.The levels of IL-27,TNF-α,CA15-3 and VEGF in pleural effusion in both groups were compared.The diagnostic value of IL-27,TNF-α,CA15-3 and VEGF in pleural effusion was determined by receiver operating characteristic(ROC)assisted.Finally,the efficacy of IL-27,TNF-α,CA15-3 and VEGF in pleural effusion in the diagnosis of lung cancer pleurisy was analyzed.Results The level of IL-27 in the tuberculous pleurisy group was(504.74±113.25)ng/L,which was significantly higher than that in the lung cancer pleurisy group[(504.74±113.25)ng/L],and the levels of TNF-α,CA15-3 and VEGF were(47.31±21.48)pg/L,(21.33±9.01)KU/L,(145.31±73.94)pg/L,which were significantly lower than those in the lung cancer pleurisy group[(94.98±57.74)pg/L,(64.71±21.48)KU/L,(419.33±101.46)pg/L],the differences were statistically significant(P<0.05).ROC analysis confirmed that IL-27,TNF-α,CA15-3 and VEGF could be used in the diagnosis of lung cancer pleurisy,and the areas under the curve were 0.935,0.840,0.949 and 0.934,respectively.In the combined diagnosis,pleural effusion IL-27≤402.920 ng/L,TNF-α≥69.188 pg/L,CA15-3≥54.082 KU/L,and VEGF≥192.705 pg/L were considered as positive,and a positive index of either was considered as positive for the combined diagnosis.Consistency analysis confirmed that 32 cases were positive in the combined diagnosis,with sensitivity of 84.2%,specificity of 96.8%,accuracy of 92.0%,positive predictive value of 0.941,negative predictive value of 0.910,Kappa=0.82

关 键 词：结核性胸膜炎 肺癌性胸膜炎 胸腔积液 白细胞介素27 肿瘤坏死因子α 糖类抗原15-3 血管内皮生长因子 

分 类 号：R521.7[医药卫生—内科学] R734.2[医药卫生—临床医学] R561.1