检测CEA mRNA、TA、ADA和TB DNA鉴别诊断恶性与结核性胸水114例临床评价

A valuation on detection of CEA mRNA,telomerase activity,TB DNA and ADA in dropsy of chest for differential diagnosis of malignant and tuberculous dropsy of chest

目的:评价应用癌胚抗原mRNA(CEA mRNA)、端粒酶活性(TA)、腺苷脱氨酶(ADA)和结核杆菌DNA(TB DNA)指标鉴别诊断恶性与结核性胸水的价值。方法:对114例恶性胸水(恶性组)和结核性胸水(结核组)患者以采集胸水为标本,应用PCR技术检测CEA mRNA、TA和TB DNA、酶动力学反应终点法检测ADA。结果:CEA mRNA、TA、ADA和TB DNA阳性结果分别为:①恶性组45例(78.9%)、45例(78.9%)、10例(17.5%)和2例(3.5%);②结核组4例(7.0%)、3例(5.3%)、48例(84.2%)和40例(70.2%)。恶性组CEA mRNA、TA和ADA(ADA<33U/L)的特异性和敏感性分别为93.0%和78.9%,94.7%和78.9%,84.2%和82.4%;结核组ADA(ADA>33U/L)和TB DNA的特异性和敏感性分别为82.5%和84.2%,96.5%和70.2%;组间具有显著性差异(P<0.001)。结论:CEA mRNA和TA指标诊断恶性胸水具有较高的特异性和敏感性,TB DNA指标诊断结核性胸水具有较高的特异性和敏感性,ADA对两种胸水的特异性较低但敏感性较高,共同应用这些指标鉴别诊断恶性与结核性胸水具有较高的应用价值。

Objective： To appraise the value on the detection of CEA mRNA, telomerase activity （TA）, ADA, and TB DNA in dropsy of chest for differential diagnosis of malignant and tuberculous dropsy of chest. Methods ： The objects consisted of 57 patients with malignant pleural effusion and 57 patients with tuberculous effusion. CEA mRNA, TA and TB DNA were detected by PCR and ADA was detected by terminal reaction of enzymology. Results. The positive results of CEA mRNA, TA, ADA and TB DNA were 45（78.9%）, 45（78.9%）, 10（17.5%） and 2（3.5%） in malignant group and 4（7.0%）, 3（5.3%）, 48（84.2%） and 40（70.2%） in tuberculous group. The specificity and sensitivity of CEA mRNA, TA and ADA （ADA〈33U/L） were 93.0% and 78.9%, 94. 7% and 78.9%, 84.2% and 82.4% in malignant group. The specificity and sensitivity of ADA （ADA〉33U/L） and TB DNA were 82. 5% and 84. 2%, 96. 5% and 70. 2% in tuberculous group. The differences of the positive results between each group had statistical meaning （P〈0. 001）. Conclusion; CEA mRNA and TA have high specificity and sensitivity in the diagnosis of malignant effusion and TB DNA has high specificity and sensitivity in the diagnosis of tuberculous effusion. ADA has high sensitivity but low specificity in differential diagnosis of tuberculous and malignant dropsy of chest. Simultaneous determination of CEA mRNA, TA, TBDNA and ADA is valuable for the differential diagnosis of malignant and tuberculous dropsy of chest.