ADA、CEA及GLU在癌性及结核性胸腔积液性质诊断的临床应用价值

Study on the clinical application value of ADA,CEA and GLU in the cancerous and tuberculous pleural effusion diagnosis

目的研究胸水腺苷酸脱氨酶(ADA)、癌胚抗原(CEA)以及葡萄糖(GLU)的检测对癌性及结核性胸水性质的鉴别价值。方法 158例癌性胸腔积液设为癌性组,135例结核性胸腔积液设为结核组,观察两组胸水ADA、CEA及GLU变化情况,并运用ROC曲线对三指标对癌性胸腔积液及结核性胸腔积液的诊断进行评价。结果癌性组与结核组胸水ADA、CEA及GLU统计学差异均有显著性(P<0.01),癌性组CEA出现大幅升高,结核组ADA出现升高,Glu出现下降;在293例研究对象中根据临床最终确诊为诊断依据,ADA的对癌性胸水诊断切点为26u/l,ROC曲线下面积(AUC)为0.900,对应灵敏度(0.8444)、特异度(0.8734)、约登指数(0.7179)、阳性预测值(0.8507)、阴性预测值(0.8679);Glu对癌性胸水诊断切点为4.5 mmol/l,ROC曲线下面积(AUC)为0.789,对应灵敏度(0.9259)、特异度(0.563)、约登指数(0.4889)、阳性预测值(0.7177)、阴性预测值(0.8636);CEA对癌性胸水诊断切点为7ng/ml,ROC曲线下面积(AUC)为0.906,诊断切点对应灵敏度(0.9556)、特异度(0.7278)、约登指数(0.6834)、阳性预测值(0.7500)、阴性预测值(0.9504)。结论 ADA、CEA及GLU对癌性胸水及结核性胸水的鉴别有重要的临床应用价值。

Objective To study the pleural fluid adenosine deaminase （ADA）,carcinoembryonic antigen （CEA）and glucose （GLU）value of the detection of cancer and tuberculous pleural effusion.Methods 158 patients with malignant pleural effusion for cancer group,135 cases of tuberculous pleural effusion as tuberculosis group,observe two groups of ADA,CEA and GLU in pleural changes,and use ROC curve to evaluate the diagnosis of the three indicators of malignant pleural effusion and tuberculosis pleural effusion.Results cancerous pleural effusion group and tuberculosis group ADA,CEA and GLU differences were statistically significant （P 〈0.01）,cancer group CEA sharp rise in tuberculosis group appeared elevated ADA,Glu declined;in 293 cases studies objects based on clinical diagnosis eventually diagnosed as basis for the diagnosis of malignant pleural effusion ADA cut point for 26 u/l,the area under the ROC curve （AUC） of 0.900,corresponding to the sensitivity of the diagnostic cut-off point （0.8444）,specificity （0.8734）,about Gordon index （0.7179）,positive predictive value （0.8507）,negative predictive value （0.8679）;the diagnosis of malignant pleural effusion cut point Glu is 4.5 mmol/l,ROC area under the curve （AUC）was 0.789,corresponding to the sensitivity of the diagnostic cut points （0.9259）,specificity （0.563）,Youden index （0.4889）,positive predictive value （0.7177）, negative predictive value （0.8636）;the diagnosis of malignant pleural effusion CEA cut-off point for 7 ng/ml,area under the ROC curve （AUC）was 0.906,corresponding to the sensitivity of the diagnostic cut-off point （0.9556）,specificity （0.7278）,Youden index （0.6834）,positive predictive value （0.7500）,negative predictive value （0.9504）.Conclu-sion It has important clinical value to identify Cancerous Pleural Effusion and tuberculosis pleural effusion with ADA, CEA and GLU.