转化生长因子-β1联合腺苷脱氨酶、GeneXpert MTB/RIF在结核性胸膜炎诊断中的应用观察  

Observation of application of TGF-β1 combined with ADA and GeneXpert MTBRIF in the diagnosis of tuberculous pleural effusion

作　　者：王霞[1] 张利利[1] 李晓阳[1] 韩伟[1] 谭磊 姜玉华 WANG Xia;ZHANG Li-li;LI Xiao-yang;HAN Wei;TAN Lei;JIANG Yu-hua(The First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院,河南新乡453100

出　　处：《实用医院临床杂志》2024年第2期50-53,共4页Practical Journal of Clinical Medicine

基　　金：河南医学科技攻关计划项目(编号:LHGJ20220594)。

摘　　要：目的观察转化生长因子-β1(TGF-β1)联合腺苷脱氨酶(ADA)、GeneXpert MTB/RIF在结核性胸膜炎(TPE)诊断中的应用效果。方法选取2020年8月至2022年8月因渗出性胸腔积液来我院就诊的患者220例,病理检查最终确诊为TPE 92例(TPE组),细菌性胸腔积液(BPE)68例(BPE组),恶性胸腔积液(MPE)60例(MPE组),测定胸腔积液TGF-β1、ADA,并对胸腔积液进行GeneXpert MTB/RIF检测,比较三组检测结果,分析胸腔积液TGF-β1、ADA单独及联合检测对TPE的诊断价值并确定最佳截断值,分析TGF-β1、ADA、GeneXpert MTB/RIF单独及联合诊断TPE与病理诊断的一致性。结果三组胸腔积液TGF-β1及ADA水平比较,TPE组均为最高,其次是BPE组,MPE组最低(P<0.05);ROC曲线显示,TGF-β1、ADA诊断TPE的最佳截断值分别为31.155 ng/L、28.495 U/L,对应的曲线下面积(AUC)分别为0.935、0.934,联合诊断AUC为0.987;TGF-β1、ADA联合诊断与病理诊断一致性Kappa值为0.76,GeneXpert MTB/RIF单独诊断Kappa值为0.71,联合诊断Kappa值为0.83。结论TPE患者胸腔积液TGF-β1、ADA均高于细菌性及恶性胸腔积液类型,GeneXpert MTB/RIF联合胸腔积液TGF-β1、ADA检测对TPE具有较高的诊断价值,与病理诊断一致性良好。Objective To observe the application effects of transforming growth factor-β1(TGF-β1)combined with adenosine deaminase(ADA)and GeneXpert MTB/RIF in the diagnosis of tuberculous pleural effusion(TPE).Methods Two hundred and twenty patients who came to the hospital due to exudative pleural effusion from August 2020 to August 2022 were selected as research subjects.The final pathological examination confirmed that there were 92 patients with TPE(TPE group),68 with bacterial pleural effusion(BPE)(BPE group)and 60 with malignant pleural effusion(MPE)(MPE group).The TGF-β1 and ADA in pleural effusion were detected.GeneXpert MTB/RIF in pleural effusion was conducted.The diagnostic value of pleural effusion TGF-β1 and ADA alone and in combination on TPE was analyzed and the best cut-off values were determined.The consistency of TGF-β1,ADA,GeneXpert MTB/RIF alone and in combination with pathological diagnosis was analyzed.Results The levels of TGF-β1 and ADA in pleural effusion were the highest in the TPE group,followed by the BPE group,and the lowest in the MPE group(P<0.05).ROC curve analyses showed that the best cut-off values of TGF-β1 and ADA in the diagnosis of TPE were 31.155ng/L and 28.495U/L,respectively.The corresponding areas under the curves(AUCs)were 0.830 and 0.851,respectively,and the combined diagnosis was 0.904.The consistency Kappa value of the combined detection of TGF-β1 and ADA with pathological diagnosis was 0.76.The consistency Kappa value of GeneXpert MTB/RIF with pathological diagnosis was 0.71.The consistency Kappa value of the combined diagnosis of TGF-β1,ADA and GeneXpert MTB/RIF with pathological diagnosis was 0.83.Conclusions The levels of TGF-β1 and ADA in pleural effusion of patients with TPE are higher than those of patients with bacterial and malignant types of pleural effusion.GeneXpert MTB/RIF combined with pleural effusion TGF-β1 and ADA detection has a high diagnostic value on TPE.It also has a good consistency with pathological diagnosis.

关 键 词：转化生长因子-Β1 腺苷脱氨酶 GeneXpert MTB/RIF 结核性胸膜炎 诊断价值 

分 类 号：R521.7[医药卫生—内科学]