端粒酶、γ-干扰素、腺苷酸脱氨酶及结核感染T细胞斑点试验在诊断结核性和恶性胸腔积液中的作用分析  

Roles of telomerase,interferon⁃γ,adenosine deaminase and T cell spot test in diagnosis of tuberculous and malignant pleural effusion

作　　者：由振华[1] 黄锦宏[1] 赵云根[1] 顾宇平[1] 程易[1] 凌春华[2] You Zhenhua;Huang Jinhong;Zhao Yungen;Gu Yuping;Cheng Yi;Ling Chunhua(Department of Respiratory Medicine,Changshu No.2 People’sHospital,Changshu 215500,China)

机构地区：[1]常熟市第二人民医院呼吸内科,江苏常熟215500 [2]苏州大学附属第一人民医院呼吸内科

出　　处：《海军医学杂志》2024年第1期53-57,共5页Journal of Navy Medicine

摘　　要：目的 评价端粒酶、γ-干扰素(IFN-γ)、腺苷酸脱氨酶(ADA)及T细胞斑点试验(T-SPOT.TB)检测在诊断结核性和恶性胸腔积液中的价值。方法 纳入40例早期结核性胸膜炎患者(结核组)和40例恶性胸腔积液患者(肿瘤组),分别在治疗前抽取患者胸腔积液及空腹血液,应用酶联免疫吸附分析法检测端粒酶的含量和IFN-γ的浓度,应用比色分析法检测ADA的活性,采用Elispot斑点计数检测T-SPOT.TB阳性率。结果 结核组和肿瘤组的端粒酶含量分别为(1.46±0.73)×10~(-3) nmol/L和(3.34±1.72)×10~(-3) nmol/L,结核组端粒酶含量低于肿瘤组(P<0.01);结核组和肿瘤组的IFN-γ含量分别为(137.44±38.93) U/L和(27.94±8.46) U/L,ADA含量分别为(68.42±9.58) U/L和(15.39±4.43) U/L,2组患者IFN-γ含量和ADA含量比较,差异有统计学意义(P<0.01)。结核组IFN-γ浓度、ADA活性及T-SPOT.TB阳性率均高于肿瘤组(P<0.01)。联合应用端粒酶、IFN-γ、ADA及T-SPOT.TB 4个诊断指标的诊断试验鉴别诊断结核性和恶性胸腔积液的敏感度为0.974,特异度为0.974。结论 联合应用端粒酶、IFN-γ、ADA及T-SPOT.TB 4个诊断指标的诊断试验在结核性胸腔积液和恶性胸腔积液的鉴别诊断中具有重要意义。Objective To evaluate the roles of telomerase,interferon‐γ(IFN‐γ),adenosine deaminase(ADA)and T cell spot test(T‐SPOT.TB)in the diagnosis of tuberculous and malignant pleural effusion.Methods Forty patients with early tuberculous pleurisy(tuberculosis group)and 40 patients with malignant pleural effusion(tumor group)were enrolled.Pleural effusion and fasting blood were extracted before treatment.The activity of telomerase and the concentration of IFN‐γwere detected by enzyme‐linked immunosorbent assay.The activity of ADA was detected by colorimetric analysis.The positive rate of T‐SPOT.TB was detected by Elispot spot counting.Results Telomerase activity in the tuberculosis group was significantly lower than that in the tumor group([1.46±0.73]×10‐3 nmol/L vs.[3.34±1.72]×10‐3 nmol/L,P<0.01).The concentration of IFN‐γwas(137.44±38.93)U/L and(27.94±8.46)U/L in the tuberculosis group and tumor group,respectively;ADA content was(68.42±9.58)U/L and(15.39±4.43)U/L.There were significant differences in IFN‐γand ADA between the 2 group(P<0.01).IFN‐γconcentration,ADA activity and the positive rate of T‐SPOT.TB in the tuberculosis group were significantly higher than those in the tumor group(P<0.01).The sensitivity and specificity of combined detection of telomerase,IFN‐γ,ADA and T‐SPOT.TB in differentiating tuberculous and malignant pleural effusion were 0.974 and 0.974,respectively.Conclusion The combined detection of telomerase,IFN‐γ,ADA and T‐SPOT.TB has important value in differential diagnosis of tuberculosis and malignant pleural effusion.

关 键 词：端粒酶 Γ-干扰素 腺苷酸脱氨酶 T细胞斑点试验 结核性胸腔积液 恶性胸腔积液 

分 类 号：R521.1[医药卫生—内科学]