结核性胸腔积液中 D- 二聚体测定及意义

The diagnostic value of pleural fluid dimer levels in tuberculous pleural effusion

目的测定胸腔积液中D-二聚体水平。同时与胸腔积液中腺苷脱氨酶（ADA）水平比较，探讨胸水D-二聚体检测对结核性胸腔积液（TP）的诊断意义。方法分别采用速率法和酶标记免疫吸附测定法（ELISA法）测定临床确诊的30例TP和25例恶性胸腔积液（MP）患者的胸腔积液ADA、D-二聚体含量。结果ADA在TP中的含量为（5347±23．70）u／L，在MP中的含量为（1452±4．25）u／L；D-二聚体在TP中的含量为（70．63±3778）mg／L，在MP中的含量为（2844±1771）mg／L，TP中ADA、D-二聚体含量均高于MP，差异有统计学意义（P〈0．01）。胸腔积液ADA诊断TP的ROC曲线下面积为0955，以ADA〉40u／L为界值，诊断TP的敏感性为66.7％，特异性为100％，阳性预测值100％，阴性预测值71．4％，准确度81．8％。胸腔积液D-二聚体诊断TP的ROC曲线下面积为0、869，以D-二聚体〉55．5mg／L为界值，诊断TP的敏感性为667％，特异性为96％，阳性预测值952％，阴性预测值706％，准确度80％。结论TP中D-二聚体含量高于MP，检测胸腔积液D-二聚体含量对TP具有一定诊断价值。

Objective This study was designed to assess the diagnostic value of pleural fluid dimer levels in tuberculous pleural effusion in comparison with pleural fluid adenosine deaminase levels. Methods Pleural fluid adenosine deaminase （ADA） and dimer levels were measured in 30 patients with tuberculous pleurisy （TP） and 25 patients with malignant pleurisy （MP）.ADA levels were determined by a velocity method, whereas dimer levels were determined by a enzyme linked immunosorbent assay （ELISA） method. Results ADA levels were （53.47 _＋ 23.70） u/L in the TP group and （14.52 _＋ 4.25） u/L in the MP group. Dimer levels were （70.63±37.78）mg/L in the TP group and （28.44±17.71） mg/L in the MP group. The median pleural fluid ADA and dimmer levels in TP were higher than in MP. The difference was statistically significant （ P 〈0.001 ）. The area under ROC curve of ADA in pleural fluid was 0.955 to diagnose TP. When the cutoff was 〉40 u/L, the sensitivity was 66.7%, specificity was 100%, positive predictive value was 100% ,negative predictive value was 71.4% and accuracy was 81.8%. The area under ROC curve of Dimer in pleural fluid was 0.869 to diagnose TP and the cutoff of dimmer was 〉55.5mg/L with sensitivity of 66.7%, specificity of 96%, positive predictive value of 95.2%, negative predictive value of 70.6% and accuracy of 80%. Conclusion Dimer concentration was significantly higher in tuberculous pleural effusion when compared to malignant pleural effusion with some diagnostic value and its clinical use as a diagnostic marker is not valuable as ADA.However, symphysic determination between ADA and dimmer may provid more information to diagnose tuberculous pleural effusion and the determination of pleural fluid dimer levels in tuberculous pleural effusion can provid therapeuticevidence about anticoagulant therapy in cavum thoracis for patients.