检测LAM-IgG、TB-DNA、ADA、CEA、CEA-mRNA鉴别诊断结核性与恶性胸水

Detection of lipoarabinomannan antibody-IgG, Mycobacterium tuberculosis-DNA,adenosine deaminase,carcinoembryonic antigen and carcinoembryonic antigen-mRNA for differential diagnosis of tuberculous or malignant dropsy of chest

目的 评价应用胸水标本检测阿拉伯糖甘露糖脂IgG抗体(LAM -IgG)、结核杆菌DNA(TB -DNA)、腺苷脱氨酶(ADA)、癌胚抗原(CEA)和CEA mRNA等项指标诊断结核性与恶性胸水的价值。方法 结核性胸水(结核组)和恶性胸水(恶性组)各53例,采集胸水为检测标本,应用斑点免疫金渗滤试验技术检测LAM IgG、酶促反应终点法检测ADA、磁酶免技术检测CEA、聚合酶链反应(PCR)技术检测TB DNA和CEA -mRNA。结果 LAM IgG、TB DNA、ADA、CEA和CEA mRNA的阳性结果分别为:结核组32 (60.4%)、38 (71.7%)、44 (83.0%)、3 (5.7%)和4(7.5%),恶性组4(7.5%)、2(3.8%)、8(15.1%)、31(58.5%)和43(81.1%),组间比较差异有统计学意义(P均<0.01)。结论 LAM -IgG、TB -DNA在诊断结核性胸水方面具有较高的特异性和敏感性,CEA、CEA- mRNA在诊断恶性胸水方面具有较高的特异性和敏感性,ADA对两种胸水诊断的特异性较低,但敏感性较高。

Objective To appraise the applied value for differential diagnosis of tuberculous or malignant plural effusion on the detection of lipoarabinomannan antibody IgG(LAM-IgG), Mycobacterium tuberculosis DNA(TB-DNA), adenosine deaminase(ADA), carcinoembryonic antigen(CEA) and carcinoembryonic antigen mRNA(CEA-mRNA) in dropsy of chest. Methods There were 106 subjects consisting of 53 patients with tuberculous plural effusion(tuberculous group) and 53 patients with malignant plural effusion (malignant group) in the study. LAM-IgG was detected by dot immunogold filtration assay . ADA was detected by terminal reaction of enzymology. Magnetic antibody immunoenzymetric assay was used for detection of CEA and PCR detected TB-DNA and CEA-mRNA in plural effusion. Results The positive results of LAM-IgG, TB-DNA, ADA, CEA and CEA-mRNA were 32( 60.4%), 38( 71.7%), 44( 83.0%), 3( 5.7%) and 4( 7.5%) respectively in the tuberculous group and 4( 7.5%), 2( 3.8%), 8( 15.1%), 31( 58.5%) and 43( 81.1%) respectively in the malignant group. The positive results between the two groups had statistical differences(P< 0.01). Conclusion LAM-IgG and TB-DNA have higher specificity and sensitivity in the diagnosis of tuberculous plural effusion, CEA and CEA-mRNA have higher specificity and sensitivity in the diagnosis of malignant dropsy of chest, and ADA has higher sensitivity and lower specificity in differential diagnosis of tuberculous and malignant plural effusion.