白细胞介素-18及血管内皮生长因子检测对结核性和恶性胸腔积液的鉴别诊断

Significance of Interleukin-18 (IL-18) and Vascular Endothelial Growth Factor (VEGF) in Differentiating Tuberculous Pleural Effusion from Malignant Pleural Effusions

目的:探讨白细胞介素-18(IL-18)及血管内皮生长因子(VEGF)检测在结核性和恶性胸腔积液鉴别诊断中的价值。方法:选择结核性胸腔积液52例设为结核组,恶性胸腔积液50例设为恶性组,分别采用酶显色法、酶免疫法检测胸腔积液中腺苷脱氨酶(ADA)、癌胚抗原(CEA)水平,采用双抗体夹心酶联免疫吸附(ELISA)法检测IL-18和VEGF水平。应用受试者工作特征(ROC)曲线计算上述指标和VEGF/IL-18比值的诊断敏感度、特异度、准确度及ROC曲线下面积。结果:结核组ADA、IL-18水平显著高于恶性组(P<0.01);恶性组CEA、VEGF水平及VEGF/IL-18比值显著高于结核组(P<0.01);IL-18诊断结核性胸腔积液的敏感度、特异度、准确度及ROC曲线下面积高于ADA(P<0.05);VEGF/IL-18比值对恶性胸腔积液诊断的敏感度、特异度、准确度及ROC曲线下面积显著高于CEA和VEGF(P<0.01)。结论:IL-18和VEGF/IL-18比值可作为临床上鉴别结核性和恶性胸腔积液的良好指标。

Objective ：To evaluate the significance of interleukin-18 （IL-18） and vascular endothelial growth factor （VEGF） in differentiating tuberculous pleural effusions from malignant pleural effusions. Methods： 52 cases with tuberculous pleural effusions and 50 cases with malignant pleural effusions were enrolled in the study. Adenosine deaminase （ ADA ） , carcinoembryonic antigen （CEA） , IL-18 and VEGF levels in pleural effusions were tested. The sensitivity, specificity and accuracy of ADA, CEA, IL-18,VEGF,VEGF/IL-18 ratio and area under the receiver operating characteristic （ROC） curve were obtained through ROC curve. Results：The ADA,IL-18 levels of tuberculous group were significantly higher than that of malignant group （P 〈 0. 01 ）, while CEA,VEGF levels and VEGF/IL-18 ratio of tuberculous group were significantly lower than that of malignant group （P 〈 0. 01 ）. The sensitivity,specificity,area under the ROC curve accuracy for tuberculous pleural effusions of IL-18 were higher than that of ADA （ P 〈 0. 05 ）. The sensitivity, specificity, accuracy, area under the ROC curve for malignant pleural effusions of VEGF/IL-18 ratio were higher than that of CEA and VEGF （P 〈0. 01 ）. Conclusion： IL-18 and VEGF/IL-18 ratio can be used as valuable parameters for the differentiation of tuberculous pleural effusions from malignant pleural effusions.