胸水ADA、CEA检测在结核性与癌性胸膜炎鉴别诊断中的价值

Differential Diagnosis Value of Pleural Fluid ADA and CEA Detection for Tuberculous Pleuritis and Carcinomatous Pleuritis

[目的]探讨胸水腺苷脱氨酶(ADA)和癌胚抗原(CEA)检测在结核性胸膜炎与癌性胸膜炎鉴别诊断中的价值。[方法]选择38例结核性胸膜炎和42例癌性胸膜炎住院患者,用速率法检测胸水ADA活性,电化学发光免疫法检测胸水CEA,评价二者诊断的真实性、预测值和似然比。[结果]结核性胸膜炎组ADA阳性率86.8%高于癌性胸膜炎组的2.4%(P<0.01);癌性胸膜炎组CEA阳性率71.4%高于结核性胸膜炎组的2.6%(P<0.01)。ADA诊断结核性胸膜炎的敏感性为86.8%、特异性97.6%、正确诊断(约登)指数(Yoden’s index)0.84、阳性预测值97.1%、阴性预测值89.1%、阳性似然比36.49、阴性似然比0.14;CEA诊断癌性胸膜炎的敏感性71.4%、特异性97.4%、约登指数0.84、阳性预测值96.8%、阴性预测值75.51%、阳性似然比27.16、阴性似然比为0.29。[结论]检测胸水ADA、CEA在结核性胸膜炎与癌性胸膜炎鉴别诊断中有重要的临床意义。

[Objective] To investigate the differential diagnosis value of pleural fluid ADA and CEA detection for tuberculous pleuritis （TP） and carcinomatous pleuritis （CP）. [Methods] Totally 38 TP and 42 CP cases were selected for differential diagnosis. ADA activity and CEA value were detected by velocity method and immunization method of electro-chemiluminescence respectively, The validity, predictive value and likelihood ratio of TP and CP were evaluated. [Results] ADA positive rate of TP （86.8%） was higher than that of CP （2. 4%） （P〈0. 01）;CEA positive rate of CP （71.4%） was higher than that of TP group（2.6%）（P〈0.01）. The sensitivity, specificity, Yoden＇s index, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of ADA in diagnosing TP were 86.8 %, 97.6 %, 0.84,97. 1%, 89. 1%, 36.49 and 0.14 respectively; The indexes as mentioned above of CEA in diagnosing CP were 71.4%, 97.4%, 0. 84, 96.8%, 75.5%, 27. 16 and 0.29 respectively. [Conclusion] Detection of ADA and CEA in pleural fluid is of considerable clinical significance in differential diagnosis of TP and CP.