联合测定分泌型白细胞蛋白酶抑制因子和腺苷脱氨酶在结核性胸腔积液中的诊断意义

Diagnostic significance of combination of secretory leukocyte protease inhibitor and adenosine deaminase for tuberculous pleural effusion

目的探讨联合测定胸腔积液中分泌型白细胞蛋白酶抑制因子(SLPI)和腺苷脱氨酶(ADA)浓度对结核性胸腔积液的诊断价值。方法收集103例胸腔积液及其同源外周血,其中结核性胸腔积液组为45例,恶性胸腔积液组31例,细菌性胸腔积液组16例,漏出液组11例。应用ELISA法测定胸水上清液和血清中SLPI的浓度,用比色法测定ADA水平,并对结果及意义进行分析。结果 (1)结核组SLPI浓度(193790±15476)pg/ml,与恶性组(121700±13101)pg/ml、细菌组(92885±26962)pg/ml、漏出液组(109360±21619)pg/ml相比差异均有统计学意义(P<0.05);恶性组、细菌组及漏出液组间相比差异均无统计学意义(P>0.05)。结核组及细菌组ADA水平与恶性组及漏出液组比较差异有统计学意义(P<0.05)。(2)受试者工作特征曲线(ROC曲线)结果显示,胸腔积液SLPI浓度对于诊断结核性胸腔积液的最佳阈值为236071pg/ml,曲线下面积(AUC)为69.9%(95%可信区间为58.2%～81.6%),灵敏度和特异度分别为43.2%和91.4%(P<0.05);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71.9%(可信区间60.9%～82.8%)、75%、64.2%和29.5(P<0.001);SLPI和ADA同时高于各自的诊断阈值,得出最佳诊断特异度为95%;SLPI或ADA高于诊断阈值,得出最佳诊断灵敏度为89%。结论单独测定SLPI及ADA均有助于诊断结核性胸腔积液,但联合测定更能提高诊断效能。

Objective To compare the diagnostic accuracy of pleural SLPI and ADA for tuberculous pleural effusion.Methods Pleural effusion samples were obtained from 103 patients who presented to the department of respiratory diseases（45 in tuberculous pleural effusion group,31 in malignant pleural effusion group,16 in bacterial pleural effusion group and 11 in transudative pleural effusion group）.The levels of SLPI in pleural effusion and serum were determined by sandwich enzyme-linked immunosorbent assays（ELISA）.ADA activity was determined using the colorimetric method kit.Results（1） The concentrations of SLPI in tuberculous pleural effusion（193 790 ± 15 476） pg /ml was higher than that in malignant group（121 700 ± 13 101） pg /ml,in bacterial group（92 885 ± 26 962） pg /ml and in transudative group（109 360 ± 21 619） pg /ml（P ＆lt; 0.05）.But there were no statistical significance among the malignant group.bacterial group and transudative group（P ＆gt; 0.05）.The concentration of pleural ADA in tuberculous pleural effusion group and bacterial group was higher than that in malignant group and transudative group（P ＆lt; 0.05）.（2） The cut-off value of pleural SLPI for the diagnosis of tuberculous PE was 236 071 pg/ml with the corresponding sensitivity and specificity 43.2% and 91.4%,respectively.The cut-off value of pleural ADA for the diagnosis of tuberculous PE was 29.5 U /L with the corresponding sensitivity and specificity 75.0% and 64.2%,respectively.The combinations of SLPI and ADA increased specificity to 95%.The combinations of SLPI or ADA increased sensitivity to 89%.Conclusion Pleural SLPI and ADA may be helpful for the differential diagnosis of tuberculous pleural effu-sion and the other pleural effusion.The combinations of SLPI or /and ADA further increased diagnostic performance.