基质金属蛋白酶1及其组织抑制物1在结核性和肿瘤性胸腔积液鉴别诊断中的价值

The Value of Matrix Metalloproteinase-1 and Tissue Inhibitor of Metalloproteinase-1 in the Differential Diagnosis of Tuberculous and Tumorous Pleural Effusion

目的:探讨基质金属蛋白酶1(MMP-1)及其组织抑制物1(TIMP-1)在结核性和恶性胸腔积液形成过程中的作用及在上述胸腔积液诊断和鉴别诊断中的价值。方法:采用酶联免疫吸附试验(ELISA)法测定36例结核性胸膜炎、38例恶性肿瘤胸腔积液患者胸水中MMP-1和TI MP-1的浓度。结果:(1)结核性胸腔积液组胸水中MMP-1浓度、TIMP-1浓度和MMP-1/TIMP-1比值均高于恶性胸腔积液组(213.37±53.18ng.mL-1比157.43±53.79ng.mL-1;600.17±121.46ng.mL-1比512.05±89.48ng.mL-1;0.377±0.139ng.mL-1比0.318±0.121;P<0.05)。(2)以胸腔积液MMP-1 163.22ng.mL-1作为诊断分界点,其敏感性为80.6%,特异性为57.9%;以TIMP-1 550.93ng.mL-1作为诊断分界点,其敏感性为71.1%,特异性为63.9%;以MMP-1/TIMP-1比值0.313作为诊断分界点,其敏感性为66.7%,特异性为57.9%。若将MMP-1和TIMP-1串联(即两者同时高于分界点为阳性),则诊断恶性胸腔积液的特异性升高至86.8%,敏感性降低至44.4%;若将MMP-1和TIMP-1并联(即两者任何一项高于分界点为阳性),则诊断恶性胸腔积液的敏感性升高至100%,特异性降低至42.1%。结论:MMP-1和TIMP-1与结核性胸膜炎和恶性胸腔积液的形成密切相关,MMP-9/TIMP-1比例的失衡在此过程中起重要作用,检测胸水MMP-1和TIMP-1有助于结核性胸膜炎和恶性肿瘤所致胸腔积液的鉴别诊断。

Objective：The aim of this study was to explore the role of MMP-1 and TIMP-1 in the pathogenesis of tuberculous and tumorous pleural effusion,assess the value of MMP-1,TIMP-1 as well as the MMP-1/TIMP-1 ratio in the diagnosis and differential diagnosis of these two kinds of pleural effusion.Methods：MMP-1 and TIMP-1 in the pleural fluid were detected by enzyme-linked immunosorbent assay（ELISA） in the flowing two groups of patients： 36 cases with tuberculous pleuritis and 38 with malignant tumor.Results：①The levels of MMP-1,TIMP-1 and the MMP-1/TIMP-1 ratio were higher in tuberculous pleural effusion than in malignant pleural effusion（213.37±53.18 versus 157.43±53.79 ng·mL-1;600.17±121.46 versus 512.05±89.48 ng·mL-1;0.377±0.139 versus 0.318±0.121;P0.05）.②In diagnosing tuberculous pleural effusion,the sensitivity of MMP-1,TIMP-1 and MMP-1/MMP-1 ratio were respectively 80.6%,71.1% and 66.7%,the specificity were 57.9%,63.9% and 57.9%;however,in the diagnosing process,the sensitivity and specificity are 44.4% and 86.8% if we combine MMP-1 and TIMP-1 in a series way,100% and 42.1% in a parallel way.Conclusions：MMP-1 and TIMP-1 are closely related to the tuberculous and tumorous pleural effusion,and the MMP-1/TIMP-1 ratio play a great role in the pathogenesis of tuberculous and tumorous pleural effusion.Detection of MMP-1 and TIMP-1 of pleural effusion contributes to the differential diagnosis of tuberculous pleurisy and malignant pleural effusion.