胸水和血清ADA、CEA联合检测对结核性和恶性胸腔积液的诊断价值

Differential diagnostic value of pleural effusion combined with serum ADA and CEA for tuberculous and malignant pleural exudatea

目的探讨胸水和血清腺苷脱氨酶（ADA）、癌胚抗原（CEA）联合检测对结核性和恶性胸腔积液的诊断价值。方法采用酶连续监测法和酶联免疫（ELISA）双抗体夹心法对91例胸腔积液进行胸水和血清ADA和CEA检测分析。结果ADA活性在结核性和恶性胸腔积液中分别为（42．32±17．56）U／L，和（10．29±6．34）U／L（P〈0．01）。以PADA〉40U／L做为诊断结核的临界值，其灵敏性为82．5％，特异性为92．2％；以PADA／SADA〉1为临界值，其灵敏性为92．5％，特异性为90．2％。CEA活性在结核性和恶性胸腔积液中分别为（8．31±3．62）μg／L和（24．7±13．6）μzg／L（P〈0．01）。以PCEA〉20μg／L做为诊断恶性胸腔积液的临界值，其灵敏性为58．8％，特异性为95．0％；以PCEA／SCEA〉1为临界值，其灵敏性为86．3％，特异性为92．5％。结论胸腔积液ADA、CEA检测对结核性和恶性胸腔积液具有诊断与鉴别诊断价值。

Objective To study the diagnostic value of pleural effusion combined with serum adenosine demninase （ADA）, carcinoembryonic antigen （CEA） in testing tuberculous and malignant pleural exudates, Methods Diagnostic kit for carcinoe mbryonic antigen （CEA） and ADA measured by ELISA and Enzyme continuous monitoring method was examined among 9l patients with pleural exudates, ltaaults The ADA activity of tuberculous and malignant exudates were respectively （42.32 ± 17.56）U/L and （10.29 ± 6.34）U/L （P〈0.01）. If the critical value of ADA was larger than 40U/L in tuberculous diagnosis, its sensitivity was 82.5% and the specificity was 92.2% as the critical value of ADA more than 40U/L. its sensitivity was 92.5% and the specificity was 90.2% as the critical value of PADA/ SADA more than 1. The CEA activity of tuberculous and malignant exudates were respectively （8.31 ± 3.62）ug/L and （24.7 ± 13.6）ug/L （P〈0.01）. If the critical value of CEA was larger than 20μg/l, in malignant pleural exudates, its sensitivity was 58.8% and specificity was 95.0%. If the critical value of PCEA/SCEA was larger than 1 in malignant pleural exudates, its sensitivity was 86.3% and the specificity was 92.5%. Conclusion The test of ADA and CEA of pleural exudates is of great diagnostic value in patients with tuberculous and malignant pleural effusion.