检测BALF中CRP和T细胞亚群对肺结核与肺癌鉴别诊断的意义

The value of combined detection of CRP and T-lymphocyte subsets in BALF in differential diagnosis of lung cancer and tuberculosis

目的评价联合检测支气管肺泡灌洗液(BALF)中C反应蛋白(CRP)浓度及T淋巴细胞亚群在肺癌及肺结核鉴别诊断中的意义。方法对43例确诊的肺癌患者、37例肺结核患者以及20例健康体检者,采用免疫比浊法检测BALF中CRP浓度,流式细胞仪检测T淋巴细胞亚群水平。结果肺结核组BALF中CRP浓度高于健康对照组和肺癌组(P<0.05),与肺结核组和健康对照组相比,肺癌组BALF中的T细胞亚群中CD4+细胞比例和CD4+/CD8+比值显著下降(P<0.05),而CD8+比例无明显差异(P>0.05)。各种肺癌类型之间,CD4+、CD8+细胞比较无明显差异(P>0.05)。诊断肺结核时,BALF中CRP浓度为29.2 mg/L时特异性最高,为91.4%;诊断肺癌时,BALF中T细胞分类CD4+细胞比例为34.2%时特异性最高,为87.9%。结论联合检测BALF中CRP及T淋巴细胞亚群,对肺癌与肺结核的鉴别诊断具有一定的价值。

Objective To evaluate the combined detection of C-reactive protein（ CRP） and T-lymphocyte subsets in bronchoalveolar lavage fluid（ BALF） in differential diagnosis of lung cancer and tuberculosis. Methods The concentration of CRP and T-lymphocyte subsets in BALF in 43 patients with lung cancer and 37 patients with tuberculosis and 20 healthy controls were measured by immunoturbidimetry assay and flow cytometry respectively. Results The concentration of CRP in BALF in patients with tuberculosis was significantly higher than those in patients with lung cancer and healthy controls（ P 〈 0. 05）; CD4＋,CD4＋/CD8＋ratio in BALF in patients with lung cancer were much lower than those in patients with tuberculosis and healthy controls（ P 〈 0. 05） and there existed no obvious difference in CD8＋between patients with lung cancer and patients with tuberculosis（ P 〈0. 05）; there were no significant differences between CD8＋and CD4＋in patients with lung cancer of different subtypes（ P 〈 0. 05）; the highest specificity of CRP was91. 4% when its concentration in BALF was 29. 2 mg /L in the diagnosis of tuberculosis,and the ratio level of CD4＋was of the highest specificity（ 91. 4%） in the diagnosis of lung cancer when the ratio was 34. 2%. Conclusions The combined detection of the concentration of CRP and T lymphocyte subsets in BALF is of certain value in the differential diagnosis of lung cancer and tuberculosis.