胸腔积液和血清中PLD和ADA检测对结核性和恶性胸腔积液的诊断价值

Diagnostic value of ADA and PLD in pleural fluid and serum in differentiating tuberculous pleural effusion from malignant pleural effusion

目的:探讨胸腔积液和血清中脯氨酸肽酶(PLD)和腺苷脱氨酶(ADA)的检测在鉴别诊断结核性和恶性胸腔积液中的价值。方法:测定89例结核性胸腔积液患者和102例恶性胸腔积液患者胸腔积液和血清中PLD和ADA的活性,应用受试者工作特征曲线(ROC)进行评价。结果:结核性胸腔积液组胸腔积液ADA(50.10±18.00U/L)和血清ADA(17.66±6.67U/L)均高于恶性胸腔积液组(22.04±12.47U/L和11.16±4.49U/L),结核性胸腔积液组胸腔积液PLD(1345±206U/L)和血清PLD(1062±221U/L)均高于恶性胸腔积液组(1113±308U/L和737±154U/L),两组有极显著性差异(P<0.01)。胸腔积液和血清ADA的ROC曲线下面积分别为0.880和0.776。胸腔积液和血清PLD的ROC曲线下面积分别为0.911和0.907。胸腔积液ADA的最优截断点为40.0U/L时,灵敏度和特异度分别为88.8%和86.3%。血清ADA的最优截断点为13.0U/L时,灵敏度和特异度分别为78.7%和80.4%。胸腔积液PLD的最优截断点为1085U/L时,灵敏度和特异度分别为89.9%和85.3%。血清PLD的最优截断点为870U/L时,灵敏度和特异度分别为85.4%和87.3%。结论:PLD可作为鉴别诊断结核性胸腔积液和恶性胸腔积液的重要参考指标,其敏感度和特异度优于ADA。

Objective：To evaluate the diagnostic value of prolidase （PLD） and adenosine deaminase （ADA） in pleural fluid and serum in differentiating tuberculous pleural effusion from malignant pleural effusion. Methods：ADA and PLD activity in pleural fluid and serum collected from 89 patients with tuberculosis and 102 patients with malignant tumor were determined by enzyme kinetic method and ELISA respectively. Employ receiver operating characteristic curve （ROC） to evaluate diagnostic value of ADA and PLD in pleural fluid and serum. Results：ADA activity in serum and pleural fluid of tuberculous pleural effusion group （17.66±6.67 U/L and 50.10±18.00 U/L,respectively） were significantly higher than those values in malignant pleural effusion group （11.16±4.49 U/L and 22.04±12.47,respectively）. PLD activity in serum and pleural fluid of tuberculous pleural effusion group （1062±221 U/L and 1345±206 U/L,respectively） were significantly higher than those values in malignant pleural effusion group （737±154 U/L and 1113±308,respectively）. The area under ROC of ADA in pleural fluid and serum were 0.880 and 0.776 respectively. The area under ROC of PLD in pleural fluid and serum were 0.911 and 0.907 respectively. In ROC analysis,sensitivity and specificity values of ADA were 88.8% and 86.3% for a cut-off value of 40.0U/L in pleural fluid and were 78.7% and 80.4% for a cut-off value of 13.0 U/L in serum,respectively. Sensitivity and specificity values of PLD were 89.9% and 85.3% for a cut-off value of 1085 U/Lin pleural fluid and were 85.4% and 87.3% for a cut-off value of 870 U/Lin serum,respectively. Conclusion：PLD seems to better than ADA in differentiating tuberculous pleural effusion from malignant pleural effusion.