胸膜活检联合胸水标志物诊断结核性与恶性胸水的价值

Differential Diagnostic Value of Pleural Biopsy Combined with Multiple Indexe for Tuberculous and Malignant Pleural Exudates

目的探讨CRP、Glu、ADA、CEA和胸膜活检术联合应用鉴别诊断结核性和恶性胸水的价值。方法回顾性分析诊断明确的92例[男58例,女34例,平均(49.3±13.8)岁]结核性胸水和103例[男71例,女32例,平均(52.7±15.2)岁]恶性胸水CRP、Glu、ADA、CEA和胸膜活检结果。比较结核组和恶性组相关指标的异同,同时比较单个和上述指标联合诊断恶性胸水的敏感性、特异性及准确性。结果结核组CRP和ADA的含量显著高于恶性组,而Glu和CEA的含量显著低于恶性组(P<0.05)。联合指标鉴别诊断恶性胸水的敏感性、特异性和准确性分别为92.2%、100%和95.9%,准确性显著高于CRP、Glu、ADA、CEA和胸膜活检单个指标(72.8%、72.3%、80.5%、84.1%和83.1%,P<0.05)。结论联合CRP、Glu、ADA和CEA胸水标志物检测及胸膜活检在鉴别诊断结核性和恶性胸腔积液方面有较高的实用价值。

Objective To evaluate the differential diagnostic value of pleural biopsy combined with multiple index for tuberculous and malignant pleural exudates.Methods Ninty two patients with tuberculous pleural effusion and 103 patients with malignant pleural exudates were selected.The results of CRP,Glu,ADA and CEA of pleural effusions and pleural biopsy were analyzed retrospectively.The parameters of two groups were compared.Results In tuberculous pleural effusion,the CRP and ADA activity were higher compared with those in malignant pleural exudates,the Glu and CEA activity were lower compared with those in malignant pleural exudates（P〈0.05）.The sensitivity,specificity and accuracy of pleural biopsy combined with multiple indexe were 92.2%,100% and 95.9% in differential diagnostic pleural exudates,and the accuracy of pleural biopsy combined with multiple was significantly higher compared with it of CRP,Glu,ADA,CEA and pleural biopsy（72.8%、72.3%、80.5%、84.1% and 83.1%,P〈0.05）.Conclusion The pleural biopsy combined with multiple index test of pleural exudates is of great diagnostic value in patients with tuberculous and malignant pleural efusion.