不同检测指标对早期筛查结核性胸膜炎粘连的价值

The values of different detection indicators in early screening for pleural adhesion in patients with tuberculous pleurisy

目的分析不同检测指标对早期筛查结核性胸膜炎粘连的价值。方法选取2015年3月至2017年3月深圳市第三人民医院确诊的病程超过1个月,但未进行规范抗结核药物治疗的134例结核性胸膜炎患者,按胸膜粘连情况分为无粘连组(32例)和粘连组(102例)。对首次引流的胸腔积液和外周血进行常规生化检测[包括腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、单核细胞百分比(MONO%)]、C反应蛋白(CPR)、血红细胞沉降率(ESR)、酶联免疫斑点检测(ELISPOT),以及CT扫描下测量胸腔积液厚度和胸膜厚度,并对CT测量结果进行分级评分。采用SPSS17.0分析各项指标与结核性胸膜炎后期胸膜粘连的相关性,并采用Graphpad软件对有意义指标进行ROC曲线分析。结果结核性胸膜炎患者胸膜粘连组中胸腔积液中MONO%[(68.36±30.72)%]、CRP[(51.21±34.95)mg/L]、ESR[(52.37±28.44)mm/1h]、CT胸膜粘连评分[(6.76±6.03)分]、胸腔积液厚度[(33.50±16.65)mm]、胸膜厚度[(4.70±3.70)mm]、PBMC-ELISPOT-E6[(59.87±48.94)SFCs/孔]、PBMC-ELISPOT-peptide[(72.37±72.40)SFCs/孔]、PFMC-ELISPOT-E6[(244.20±28.70)SFCs/孔]、PFMC-ELISPOT-peptide[(242.00±134.20)SFCs/孔]与无粘连组[分别为(83.37±12.63)%、(58.36±47.66)mg/L、(54.36±29.92)mm/1h、(5.07±5.47)分、(28.85±21.30)mm、(3.60±3.00)mm、(60.71±64.52)SFCs/孔、(44.80±52.39)SFCs/孔、(203.10±174.70)SFCs/孔、(203.10±174.70)SFCs/孔]比较,差异均无统计学意义[t=1.882,P=0.067;t=0.520,P=0.604;t=0.511,P=0.826;t=0.943,P=0.352;t=2.352,P=0.022;t=0.584,P=0.571;t=0.400,P=0.691;t=1.310,P=0.197;t=0.914,P=0.373;t=0.720,P=0.372];仅ADA[(78.49±24.42)U/L]、LDH[(613.40±172.20)U/L]水平均高于无粘连组[分别为(49.64±18.98)U/L,(348.80±131.40)U/L](t=24.981、22.590,P值均<0.001)。对ADA、LDH值进行ROC曲线分析,两者在诊断结核性胸膜炎胸膜粘连时曲线下面积(95%CI值)、敏感度和特异度分别为0.84(0.76~0.93)、0.89(0.82~0.96),81.30%和81.82%、84.35和73.68%。结论结核性胸膜炎胸腔积液中的ADA、LDH数值水平在无粘连组和粘连组中均有明显差异,可作为预测结核性胸膜炎后期是否发生粘连的重要指标。

Objective To investigate the values of different detection indicators in early screening for pleural adhesion in patients with tuberculous pleurisy.Methods From March 2015 to March 2017 in the Third People’s Hospital of Shenzhen, 134 patients with tuberculous pleurisy who had been diagnosed for more than one month but were not treated with standardized anti-tuberculosis drugs were included in this study. Patients were divided in the adhesion group (n=102) and non-adhesion group (n=32) according to the occurrence of pleural adhesions or not. Routine biochemical tests (including detection of adenosine deaminase (ADA), lactate dehydrogenase (LDH), and percentage of monocytes (MONO%)), C-reactive protein (CPR) determination, erythrocyte sedimentation rate (ESR) determination, and enzyme-linked immunospot assay (ELISPOT) were conducted for the pleural effusions and peripheral blood. Pleural effusion thickness and pleural thickness were measured by CT scan and were scored. The correlations between various indicators and pleural adhesion in patients with tuberculous pleurisy were analyzed by using SPSS 17.0, and the receiver operating characteristic (ROC) curve analyses for the significant indicators were analyzed by Graphpad software.Results There were no statistical significances in the levels of MONO%, CRP, ESR, pleural adhesion score by CT, pleural effusion thickness, pleural thickness, PBMC-ELISPOT-E6, PBMC-ELISPOT-peptide, PFMC-ELISPOT-E6, and PFMC-ELISPOT-peptide between the patients in the adhesion group ((68.36±30.72)%, (51.21±34.95) mg/L, (52.37±28.44) mm/1h, (6.76±6.03) points, (33.50±16.65) mm, (4.70±3.70) mm, (59.87±48.94) SFCs/well), (72.37±72.40) SFCs/well, (244.20±28.70) SFCs/well, and (242.00±134.20) SFCs/well) and non-adhesion group ((83.37±12.63)%, (58.36±47.66) mg/L, (54.36±29.92) mm/1h, (5.07±5.47) points, (28.85±21.30) mm, (3.60±3.00) mm, (60.71±64.52) SFCs/well, (44.80±52.39) SFCs/well, (203.10±174.70) SFCs/well, and (203.10±174.70) SFCs/well) (t=1.882, P=0.067;t=0.520, P=0.604;t=0.511, P=0.826;t=0.943, P=0.352;t=2.352, P=0.022;t=0.584, P=0.571;t=0.400, P=0.691;t=1.310, P=0.197;t=0.914, P=0.373;and t=0.720, P=0.372, respectively). The ADA ((78.49±24.42) U/L) and LDH ((613.40±172.20) U/L) levels in the adhesion group were higher than those in the non-adhesion group (49.64±18.98) U/L and (348.80±131.40) U/L) (t=24.981 and 22.590, P values <0.001). ROC curve analysis was performed on the ADA and LDH values. The area under the curve (95%CI), sensitivity, and specificity of ADA and LDH levels in diagnosing pleural adhesion in patients with tuberculous pleurisy were 0.84 (0.76-0.93) and 0.89 (0.82-0.96), 81.30% and 81.82%, and 84.35% and 73.68%.Conclusion The levels of ADA and LDH in pleural effusion of patients with tuberculous pleurisy are significantly different in the non-adhesion group and the adhesion group, and can be used as important indicators to predict the occurrence of pleural adhesion in the late stage of tuberculous pleurisy.