IFN-γ、VEGF联合检测在结核性胸腔积液和恶性胸腔积液鉴别诊断中的价值

Clinical study on the diagnostic value of interferon-γ and vascular endothelial growth factor in differentiating tuberculous pleural effusion from malignant pleural effusion

目的探讨γ-干扰素(IFN-γ)、血管内皮生长因子(VEGF)联合检测在结核性胸腔积液(胸液)和恶性胸液鉴别诊断中的价值。方法以2004年3月—2005年5月住院的87例胸腔积液患者为研究对象,其中结核性胸液45例,恶性胸液42例,应用酶速率法检测胸液中腺苷酸脱氨酶(ADA)的活性,应用ELISA法检测IFN-γ、癌胚抗原(CEA)和VEGF的浓度。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算上述指标及VEGF/IFN-γ比值的诊断敏感性、特异性和准确性。结果结核性胸液组ADA和IFN-γ含量高于恶性胸液组,有显著性差异(P<0.01);恶性胸液组CEA、VEGF含量和VEGF/IFN-γ比值高于结核性胸液组,有显著性差异(P<0.01)。IFN-γ对结核性胸液诊断的敏感性和特异性高于ADA;VEGF/IFN-γ比值对恶性胸液诊断的敏感性和特异性高于CEA和VEGF。结论IFN-γ和VEGF/IFN-γ比值可以作为临床上鉴别结核性胸液和恶性胸液的有效指标。

Objective To evaluate the significance of interferon - γ （IFN - γ） and vascular endothelial factor （VEGF） in differentiating tuberculous pleural effusion from malignant pleural effusion. Methods forty-five patients with tuberculous pleural effusion and 42 patients with malignant pleural effusion in Wuhan Antituberculosis Institute, from March 2004 to May 2005, were the study subject. The adenosine deaminase （ADA）, IFN - γ, carcinoembryonic antigen （CEA） and VEGF levels of pleural effusion were detected. The sensitivity, specificity and accuracy of ADA, IFN - γ, CEA, VEGF and VEGF/IFN - γ ratio were obtained through ROC. Results The ADA and IFN - γ levels of tuberculous group were significantly higher than that of malignant group （P 〈 0.01）, while its CEA, VEGF levels and VEGF/IFN- γ ratio were significantly lower than that of malignant group （ P 〈 0.01 ）. The sensitivity and specificity of IFN - γ were higher than that of ADA. The sensitivity and specificity of VEGF/IFN - γ ratio were higher than that of CEA and VEGF. Conclusion IFN - γ and VEGF/IFN - γ ratio could be used as valuable parameters for the differentiation of tuberculous pleural effusion from malignant pleural effusion.