几种不同检测方法对结核性胸膜炎诊断价值分析

Analysis of the diagnostic value of three detection methods of tuberculous pleuritis

目的探讨几种不同检测方法对结核性胸膜炎诊断价值。方法检测47例胸腔积液患者,其中37例经组织病理学或病原学明确诊断的结核性胸膜炎,10例诊断为恶性胸水。检测全部患者胸水中ADA活性、抗结核分枝杆菌抗体、结核分支杆菌特异性ELISPOT检测,经统计学处理后,评价各项指标对结核性胸膜炎诊断的灵敏度、特异度及临床诊断符合率。结果结核性胸水中腺苷脱氨酶(ADA)活性、结核分枝杆菌抗体,结核分支杆菌特异性ELISPOT检测,与恶性胸水组比较差别有统计学意义,P<0.05。以45U/L为临界值,胸水中ADA对结核性胸膜炎诊断的灵敏度为70.2%(26/37),特异度45%(9/20),临床诊断符合率为74.5%(35/47);胸水中结核分枝杆菌抗体检测对结核性胸膜炎诊断的灵敏度为62.2%(23/37),特异度为33.3%(7/21),临床诊断符合率为63.8%(30/47);以胸水中致敏T淋巴细胞含量40个为临界值,对结核性胸膜炎诊断的灵敏度为97.3%(36/37),特异度为90%(9/10)。临床诊断符合率为95.7%(45/47)。结论胸水中ADA活性、结核分枝杆菌抗体检测可提高结核性胸膜炎的诊断效能,而结核分支杆菌特异性ELISPOT检测可以达到更好的快速诊断效果。

Objectlve To investgate the diagnostic value of three detection methods of tuberculous pleuritis. Methods 47 patients of pleuritis were selected,among which 37 were tuberculous pletwitis diagnosed by histopathology or etiology,and 10 were malignancy. ADA level , TB-Ab and Mtb. specific antigens by ELISPOT way were measured, then investgated for sensitivity and specificity. Results There was significant difference between tuberculous and malignant pleural effusion, considering the level of ADA, TB-Ab and Mtb. specific antigens with ELISPOT. In patients with tuberculous pleuritis ,the sensitivity of ADA（ 〉 45 U/L） ,TB-AB and Mtb. specific a,K, tigens（ 〉40 sensitized T lymphocytes ） is 70.2%（26/37）,62.2% （23/37）,97.3% （36/37） respectively,and specificity is 45% （9/20） ,33.3% （7/21） ,90% （9/10） respectively,with diagnose accordance rate 74.5% （35/47） ,63.8% （30/47） ,95.7% （45/47） res..sespectively. Conclusion Detection of ADA level and TB-Ab in pleural effusion is useful to increase diagnosis efficacy, while Mib specific antigens by ELISPOT way is a fast diagnostic method.