ROC曲线评价腺苷脱氨酶在结核性、恶性胸腔积液的鉴别诊断价值

ROC curve evaluation on value of adenosine deaminase in differential diagnosis of tuberculous pleural effusion and malignant pleural effusion

目的探讨腺苷脱氨酶(ADA)测定在结核性胸腔积液及恶性胸腔积液患者的鉴别诊断价值。方法应用受试者工作曲线(ROC)对176例结核性胸腔积液患者及162例恶性胸腔积液患者的胸腔积液ADA、血清ADA、胸腔积液ADA/血清ADA检测结果进行分析评价。结果 (1)血清ADA在两组资料间差异无统计学意义(P>0.05),胸腔积液ADA、胸腔积液ADA/血清ADA在两组资料间比较差异均有统计学意义(P<0.05),二者的敏感性分别为92.9%、71.9%,特异性分别为94.7%、100%,准确度分别为93.4%、78.6%。(2)胸腔积液ADA、胸腔积液ADA/血清ADA在ROC曲线下面积分别为0.942、0.909。胸腔积液ADA、胸腔积液ADA/血清ADA对结核性胸腔积液的临床诊断临界点分别为16.4U/L、2.57。结论胸腔积液ADA在结核性和恶性胸腔积液的鉴别中具有重要的临床价值,可作为结核性胸腔积液的生物标志物。

Objective To study the value of adenosine deaminase（ADA） in differential diagnosis of tubercu- lous pleural effusion（TPE） and malignant pleural effusion（MPE）. Methods The receiver operating curve（ROC） was adopted to analyze and evaluate the detection results of ADA in pleural effusion, ADA in serum, and their ratio in 176 cases of TPE and 162 cases of MPE. Results （1）Serum ADA had no statistical difference between them（P〉0.05）, but ADA in pleural effusion and the ratio of ADA in pleural effusion and ADA in serum were significantly different between them（P〈0.05）. Their sensitivity was 92.9 % and 71.9 % respectively, the specificity was 94.7 % and 100 respectively,the accuracy was 93.4% and 78.6%respectively. （2） The area under ROC curve of ADA in pleural ef- fusion and the ratio of ADA in pleural effusion and ADA in serum was 0. 942 and 0. 909 respectively. The clinical di- agnostic critical point of ADA in serum and the ratio of ADA in pleural effusion and ADA in serum for TPE were 16.4 U/L and 2. 57. Conclusion ADA in pleural effusion plays an important role in the differential diagnosis be- tween TPE and MPE,it is a useful biomarker for differentiating TPE from MPE.