结核性腹膜炎腹水LDH、ADA和T-SPOT检测及其诊断价值

Clinical value of combined detection of lactate dehydrogenase,adenosine dehydrogenase,and T-SPOT in the early diagnosis of tuberculous peritonitis

目的探讨乳酸脱氢酶(LDH)、腺苷脱氢酶(ADA)及T细胞斑点试验(T-SPOT)联合检测对结核性腹膜炎患者的临床诊断价值。方法回顾性分析广州市胸科医院2013年6月至2018年6月间收治的66例结核性腹膜炎患者的实验室检测结果,所有患者均行腹水LDH、ADA和T-SPOT检测。采用受试者工作特征曲线(ROC)对各指标单独检测和联合检测的预测结局进行评价,分析LDH、ADA、T-SPOT及LDH+ADA+T-SPOT诊断结核性腹膜炎的灵敏度、特异度和准确性。结果 ROC分析结果显示,LDH+ADA+T-SPOT的预测曲线下面积最大,达0.944。LDH+ADA+T-SPOT联合检测结核性腹膜炎的灵敏度、特异度、准确度、阳性预测值及阴性预测值均明显高于三项指标单一检测,差异均有统计学意义(P<0.05)。结论腹水LDH、ADA与T-SPOT联合检测有助于提高结核性腹膜炎诊断效果,具有较高的临床诊断价值。

Objective To investigate the clinical diagnostic value of lactate dehydrogenase(LDH),adenosine dehydrogenase(ADA),and T-SPOT test(T-SPOT)in patients with tuberculous peritonitis.Methods The laboratory test results of 66 patients with tuberculous peritonitis in Guangzhou Chest Hospital from June 2013 to June 2018 were retrospectively analyzed.All patients underwent ascites LDH,ADA and T-SPOT test.Receiver operating characteristic curve(ROC)was used to evaluate the predictive outcomes of individual and combined detection of each index.The sensitivity,specificity,and accuracy of LDH,ADA,T-SPOT,and LDH+ADA+T-SPOT in the diagnosis of tuberculous peritonitis were analyzed.Results ROC analysis showed that the area under the prediction curve of LDH+ADA+T-SPOT was the largest,reaching 0.944.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of LDH+ADA+T-SPOT combined detection of tuberculous peritonitis were significantly higher than those of single detection of three indicators,and the differences were statistically significant(P<0.05).Conclusion The combined detection of LDH,ADA and T-SPOT in ascites is helpful to improve the diagnostic effect of tuberculous peritonitis and has high clinical diagnostic value.