IL-27联合ADA、GeneXpert MTB/RIF在结核性胸膜炎诊断中的应用价值  

APPLICATION VALUE OF IL-27 COMBINED WITH ADA AND GENEXPERT MTB/RIF IN THE DIAGNOSIS OF TUBERCULOUS PLEURISY

作　　者：杜月菊[1] 李倩[1] 李曼[1] 冯建纯[1] 孙志平[1] DU Yueju;LI Qian;LI Man;FENG Jianchun;SUN Zhiping(Hebei Provincial Chest Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省胸科医院,河北省石家庄市050000

出　　处：《中国煤炭工业医学杂志》2023年第2期124-127,共4页Chinese Journal of Coal Industry Medicine

基　　金：河北省科技厅科技计划(编号:18277767D)。

摘　　要：目的 IL-27联合ADA、利福平耐药实时荧光定量核酸扩增检测技术(GeneXpert MTB/RIF)检测在结核性胸膜炎(TBP)诊断中的应用观察。方法 研究对象为2020年1月—2022年3月在该院就诊的疑似TBP患者123例,最终确诊为TBP的患者81例为观察组,非TBP患者42例为对照组。检测二组胸腔积液中白介素-27(IL-27)、腺苷脱氨酶(ADA)水平,绘制受试者工作特征(ROC)曲线分析其对TBP的诊断效能;并分析胸腔积液中IL-27、ADA联合GeneXpert MTB/RIF检测对TBP的诊断效能。结果 观察组IL-27、ADA水平均高于对照组(P<0.05);胸水积液中IL-27诊断TBP的AUC为0.788,临界值161.45ng/L,敏感度、特异度分别为59.26%、92.86%;胸水积液中ADA水平诊断TBP的AUC为0.991,临界值40.72U/L,敏感度、特异度分别为95.06%、95.24%;GeneXpertMTB/RIF检测诊断TBP的灵敏度为81.48%、特异度为95.24%、准确率为86.18%、阳性预测值为97.06%、阴性预测值为72.73%,Kappa值为0.714;IL-27、ADA联合GeneXpertMTB/RIF检测诊断TBP的敏感度为100.00%、特异度为80.95%、准确率为93.49%、阳性预测值为91.11%、阴性预测值为100.00%、Kappa值为0.848。结论 IL-27、ADA、GeneXpertMTB/RIF单独或联合诊断TBP均具有重要临床价值,三者联合检测其灵敏性更高,漏诊率更低。Objective To observe the application of interleukin-27(IL-27) combined with adenosine deaminase(ADA) and GeneXpert MTB/RIF in the diagnosis of tuberculous pleurisy(TBP). Methods One hundred and twenty-three patients who were suspected of TBP and treated in the hospital from January 2020 to March 2022 were selected as the research subjects.Final diagnosis showed 81 patients with TBP(observation group) and 42 patients without TBP(control group).The levels of interleukin-27(IL-27) and adenosine deaminase(ADA) in pleural effusion of the two groups were measured.ROC curves were plotted to analyze the diagnostic performance of the two in TBP.The diagnostic performance of pleural effusion IL-27 and ADA combined with GeneXpert MTB/RIF for TBP was analyzed. Results The levels of IL-27 and ADA in the observation group were higher than those in the control group(P<0.05).The AUC,cut-off value, sensitivity and specificity of pleural effusion IL-27 for diagnosing TBP were 0.788,161.45 ng/L,59.26% and 92.86%,respectively.The AUC,cut-off value, sensitivity and specificity of pleural effusion ADA for diagnosing TBP were 0.991,40.72 U/L,95.06% and 95.24%,respectively.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of GeneXpertMTB/RIF for diagnosing TBP were 81.48%,95.24%,86.18%,97.06%,72.73% and 0.714,respectively.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of IL-27 and ADA combined with GeneXpertMTB/RIF for diagnosing TBP were 100.00%,80.95%,93.49%,91.11%,100.00% and 0.848,respectively. Conclusion Alone and combined use of IL-27,ADA,GeneXpertMTB/RIF both are helpful for diagnosing TBP.Combined diagnosis with the three can achieve higher sensitivity and lower missed diagnosis rate.

关 键 词：结核性胸膜炎 胸腔积液 白介素-27 腺苷脱氨酶 利福平耐药实时荧光定量核酸扩增检测技术 

分 类 号：R392[医药卫生—免疫学]