胸水胆固醇和尿酸在鉴别渗出液和漏出液中的价值

A study on pleural fluid cholesterol determination for differentiating exudates and uric acid determination for distinguishing transudates

目的 探讨胸水胆固醇(Pch)浓度、胸水与血清胆固醇(Sch)浓度的比值(P/Sch)、胸水尿酸(Pua)浓 度对胸腔积液渗漏性的鉴别诊断价值。方法 对85例胸腔积液患者检测Pch和65例患者检测Pua,并计算出 P/Sch,分别研究Pch、P/Sch、Pua、胸水总蛋白(Ptpr)对胸水渗漏性诊断的受试者工作特征曲线(ROC)、灵敏度、 特异性与诊断效率。结果 Pch、P/Sch、Pua、Ptpr对胸水渗出液诊断的灵敏度分别为96.2%、90.4%、79.5%和 90.6%,特异性分别为100.0%、89.7%、61.9%和80.6%。Pch鉴别渗出液和尿酸鉴别漏出液的ROC曲线下面 积分别是0.986和0.655。结论 Pch、P/Sch、Ptpr对胸水渗出液具有较高的鉴别诊断价值,ROC亦证明Pch鉴 别渗出液和Pua监测漏出液是可行的,Pch的诊断效率最高(P<0.05)。Pua对胸水监测漏出液有一定价值,尿 酸增加表示机体抗氧化状态佳,提示预后较好。

Objective To investigate the value of determination of pleural fluid cholesterol(Pch) and uric acid(Pua) to distinguish transudates from exudates. Methods Pch, Pua and the pleural fluid total protein(Ptpr) levels in 85 patients were measured. The ROC, sensitivity, specifity and diagnostic efficiency were studied. Results The sensitivity of Pch,P/Sch,Pua,Ptpr to distinguish transudates from exudates were 96.2%,90.4%,79.5% and 90.6% respectively. The specifity were 100.0%,89.7%,61.9% and 80.6% respectively. The area under the curve of ROC was 0.986 and 0.655, on Pch to distinguish exudates from transudates and Pua to distinguish transudates from exudates respectively. Conclusions Pch,P/Sch and Ptpr may be helpful to differentiate exudates. It is proved by ROC that cholesterol to differentiate exudates and uric acid to distinguish transudates in pleural fluid is possible. Pch has highest diagnostic efficiency(P< 0.05). Pleural fluid uric acid may be valuable to distinguish transudates. Pua increase may be found in conditions associated with antioxidant response and suggest a good prognosis.