腺苷脱氨酶和干扰素-γ联合检测对结核性胸腔积液与恶性胸腔积液的鉴别诊断价值  

Value of adenosine deaminase and interferon-γin the differential diagnosis of tuberculous pleural effusion from malignant pleural effusion

作　　者：刘颖[1] 李国锋 曹文理 LIU Ying;LI Guo-feng;CAO Wen-li

机构地区：[1]天津市北辰医院重症医学科,天津300400

出　　处：《中国疗养医学》2023年第6期648-651,共4页Chinese Journal of Convalescent Medicine

基　　金：天津市北辰区科技计划项目(SHGY-2020004)。

摘　　要：目的探讨基于内科胸腔镜确诊的结核性胸腔积液与恶性胸腔积液患者胸腔积液中腺苷脱氨酶(adenosine deaminase,ADA)、干扰素(interferon,IFN)-γ和肿瘤坏死因子(tumor necrosis factor,TNF)-α对良、恶性胸腔积液的诊断效能。方法收集2019年1月至2021年12月在天津北辰医院治疗并通过内科胸腔镜确诊为结核性胸腔积液和恶性胸腔积液患者各40例。使用ELISA法检测患者胸腔积液中的ADA、IFN-γ、TNF-α的水平。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)比较上述三种参数单独和联合鉴别诊断结核性与恶性胸腔积液患者的效能。结果结核性胸腔积液组患者胸腔积液中的ADA、TNF-α和IFN-γ水平均高于恶性胸腔积液组,差异均有统计学意义(均P<0.05)。单一指标中TNF-α鉴别诊断良恶性胸腔积液的ROC曲线下面积最大为0.905,最佳诊断切点为30.3 ng/L,准确度为85.4%。联合诊断中ADA+IFN-γ联合预测诊断对结核性胸腔积液的曲线下面积最大为0.950,敏感度82.5%、特异度97.5%,准确度82.9%。结论ADA与IFN-γ联合诊断对结核性和恶性胸腔积液的鉴别诊断具有一定优势。Objective To investigate the diagnostic efficacy of adenosine deaminase(ADA),interferon(IFN)-γand tumor necrosis factor(TNF)-αin pleural effusion for benign and malignant pleural effusion in patients with tuberculous pleural effusion and malignant pleural effusion diagnosed by medical thoracoscopy.Methods From January 2019 to December 2021,40 patients with tuberculous pleural effusion and 40 patients with malignant pleural effusion diagnosed by thoracoscopy and treated in Tianjin Beichen Hospital were collected.ADA,IFN-γand TNF-αlevels in pleural effusion were detected by ELISA.The receiver operating characteristic curve(ROC)was used to compare the efficacy of the above three parameters individually and in combination in differentiating patients with tuberculous and malignant pleural effusion.Results ADA,IFN-γand TNF-αlevels in tuberculous pleural effusion group were higher than those in malignant pleural effusion group,and the differences were statistically significant(all P<0.05).The maximum area under ROC curve of the differential diagnosis of benign and malignant pleural effusion by TNF-αwas 0.905,the optimal diagnostic cut-off point was 30.3 ng/L,and the accuracy was 85.4%.The maximum area under the curve of ADA+IFN-γcombined prediction for tuberculous pleural effusion was 0.950,with a sensitivity of 82.5%,specificity of 97.5%and accuracy of 82.9%.Conclusion ADA and IFN-γcombined diagnosis has certain advantages in the differential diagnosis of tuberculous and malignant pleural effusion.

关 键 词：内科胸腔镜 腺苷脱氨酶 干扰素-Γ 胸腔积液 

分 类 号：R521.7[医药卫生—内科学] R730.43[医药卫生—临床医学]