联合检测IFN-γ、VEGF-C、CRP及ADA对结核性与恶性胸腔积液鉴别诊断的价值

Value of Combined Detection of Interferon-γ,Vascular Endothelial Growth Factor,C-reactive Protein and Adenosine Deaminase in Differential Diagnosis of Tuberculous and Malignant Pleural Effusion

目的探讨干扰素-γ(IFN-γ)、血管内皮生长因子(VEGF-C)、C-反应蛋白(CRP)及腺苷脱氨酶(ADA)在结核性与恶性胸腔积液鉴别诊断中的应用价值。方法检测122例临床确诊的胸腔积液患者(恶性胸腔积液56例,结核性胸膜炎48例,其他类型18例)胸水和血清中的IFN-γ、VEGF-C、CRP及ADA含量。结果结核组的IFN-γ、CRP浓度及ADA活性明显高于恶性肿瘤组,差异有统计学意义(P<0.01),根据受试者工作特征(ROC)曲线结果判断,以100ng/L为临界值,IFN-γ对结核性胸腔积液诊断的灵敏度、特异性分别为83.1%、92.3%;以45U/L为临界值,ADA对结核性胸腔积液诊断的灵敏度、特异性分别为85.6%、96.3%;以110mg/L为临界值,CRP对结核性胸腔积液诊断的灵敏度、特异性分别为79.1%、84.2%;三项指标联合检测,其灵敏度、特异性分别达到87.8%和86.0%。恶性胸腔积液中VEGF-C高于结核性及其他类型胸腔积液(P<0.01);VEGF-C/ADA≥8对恶性胸腔积液诊断的灵敏度、特异性分别为86.3%、82.6%;VEGF-C/ADA≤3对结核性胸腔积液诊断的灵敏度、特性度分别为85.1%、87.1%。结论联合检测IFN-γ、VEGF-C、CRP及ADA可以提高结核性胸膜炎诊断的灵敏度及特异性,VEGF-C与ADA浓度比值对胸腔积液的鉴别诊断具有较好的临床价值。

Objective To explore the value of interferon Ⅱ , vascular endothelial growth factor, C-reactive protein and adenosine deaminase in differential diagnosis of tuberculous and malignant pleural effusion. Methods 122 cases with tuberculous pleurisy, 56 cases of malignant pleural effusion, 48 cases of tuberculous pleural effu- sion, 18 cases of inflammatory and other pleural fluid were studied. The serum and pleural fluid levels of IFN-γ, VEGF-C, CRP and ADA serum in those patients were detected. Results The IFN-γ, CRP and ADA levels in tuberculous pleural effusion Were higher than in malignant pleural effusion （P 〈0.01 ）. According to the receiver operator characteristic （ROC） curve , when lOOng/L was regarded as critical value of IFN-γ, sensitivity and specificity of IFN-3, in diagnosing tuberculous pleural effusion were 83.1% and 92.3% respec- tively. When 45U/L ADA was regarded as critical value of ADA, the sensitivity and specificity of ADA in diag- nosing tuberculous pleural effusionwere 85.6% and 96.3% respectively. When 110mg/L was regarded as crit- ical value of CRP, the sensitivity and specificity of CRP were 79.1% and 84.2% respectively. When combine detection of three markers, the diagnosis sensitivity and specificity were 87.8% and 86.0% respectively. The VEGF-C concentration in malignant pleural effusion was higher than that in tuberculous pleural effusion and inflammatory and other pleural effusion （P 〈0.01 ）. When the ratio of VEGF-C to ADAm〉8, the sensitivity and specificity in diagnosis of malignant pleural effusion were 86.3% and 82.6% respectively, and the ration VEGF-C to ADA ≤ 3, the sensitivity and specificity in diagnosis of tuberculous pleural effusion were 85.1% and 87.1% respectively. Conclusion The combined detection of IFN-γ, CRP and ADA could improve sensitiv- ity and specificity in diagnosing tuberculous pleurisy. The concentration ratios of VEGF- C to ADA have clinical value in differential diagnosis of pleural effusions.