Toll样受体-2与腺苷脱氨酶测定对结核性胸水的诊断意义

Diagnostic Accuracy of Toll-Like Receptor-2 and Adenosine Deaminase for Tuberculous Pleural Effusion

目的探讨胸腔积液中Toll样受体-2(TLR-2)和腺苷脱氨酶(ADA)的水平对结核性胸腔积液的诊断价值。方法结核性胸腔积液35例,恶性胸腔积液31例,细菌性胸腔积液22例,用ELISA法测定胸水上清液和血清TLR-2水平,比色法测定ADA水平。结果 (1)结核组TLR-2浓度为(23.21±2.17)ng/L,高于恶性组(15.50±1.37)ng/L、细菌组(13.99±2.36)ng/L(P<0.05);恶性组、细菌组间比较差异无统计学意义(P>0.05)。结核组及细菌组ADA水平均低于恶性组(P<0.05)。(2)受试者工作特征曲线(ROC曲线)结果显示:胸腔积液TLR-2浓度对于诊断结核性胸腔积液的最佳阈值为31.15 ng/L、曲线下面积(AUC)为69.40%(95%CI:57.50%～81.30%),灵敏度和特异度分别为28.13%、97.90%;ADA对于诊断结核性胸腔积液的曲线下面积、灵敏度、特异度、诊断阈值分别是59.80%(95%CI:46.80%～72.70%)、77.00%、58.30%和27.50 U/L;同时检测TLR-2和ADA的诊断特异度为100%;联合检测TLR-2和ADA的诊断灵敏度为84.40%。结论单独测定TLR-2及ADA均有助于诊断结核性胸腔积液,联合指测更能提高诊断效能。

Objective To investigate the diagnostic accuracy of pleural toll-like receptor-2（TLR-2） and adenosine deaminase（ADA） for tuberculous pleural effusion（TPE）.Methods Pleural effusion samples were obtained from 88 patients（35 with TPE,31 with malignant pleural effusion,22 with bacterial pleural effusion）.Enzyme-linked immunosorbent assay（ELISA） was used to detect the pleural effusion and serum levels of TLR-2,and colorimetry method was used to determine ADA activity.Results ①The concentration of TLR-2 in the TPE group[（23.21 ± 2.17） ng / L]was higher than that in the malignant group[（15.50 ± 1.37） ng / L],and that in the bacterial group[（13.99 ± 2.36） ng / L]（P 0.05）;There was no significant difference in the concentration of TLR-2 between malignant group and bacterial group（P 0.05）.The ADA levels in the TPE group and bacterial group were lower than that in the malignant group（P 0.05）.②The receiver operating characteristic curve showed that the cut-off value of pleural TLR-2 for the diagnosis of TPE was 31.15ng / L with the corresponding sensitivity and specificity of 28.13% and 97.90%,respectively,the area under curve（AUG） was 69.40%,95% confidence interval（CI） ： 57.50%-81.30%;The cut-off value of pleural ADA for the diagnosis of TPE was 27.50 U / L with the corresponding sensitivity and specificity of 77.00% and 58.30%,respectively,the AUG was 59.80%,95% CI： 46.80%-72.70%;The combination of TLR-2 and ADA increased the specificity to 100% as well as increased the sensitivity to 84.40%.Conclusion Pleural TLR-2 or ADA may be helpful for the differential diagnosis of tuberculous pleural effusion.The combination of TLR-2 and ADA may further improve the diagnostic accuracy.