腺苷脱氨酶对结核性胸腔积液的诊断价值

Diagnostic value of adenosine deaminase（ADA） for the tuberculous pleural effusion

目的：探讨腺苷脱氨酶（ ADA）对结核性胸腔积液的诊断价值。方法回顾性分析经诊断性抗结核治疗有效确诊为结核性胸腔积液324例与确诊为恶性胸腔积液68例，绘制患者ADA值的受试者工作特征曲线（ ROC），确定鉴别两者的最佳临界值（ cut-off值），分析ADA值在结核性胸腔积液患者中的分布特点。结果以ADA 19．5 U／L作为临界值，有很好的诊断价值。 ADA值在男女结核性胸腔积液之间差异无统计学意义（Z＝－0．572，P＝0．283）。结核性脓胸与单纯结核性胸膜炎、年龄≤45岁与＞45岁组之间ADA值比较差异均有统计学意义（ Z＝－2．317，P＝0．01；Z＝－2．387，P＝0．008）。结核性脓胸组与单纯结核性胸膜炎组ADA值之间比较，在年龄≤45岁组差异有统计学意义（Z＝－2．740，P＝0．003），但在年龄＞45岁组差异无统计学意义（Z＝－0．267，P＝0．390）。结论 ADA对鉴别结核性与恶性胸腔积液有很好的诊断价值，在结核性脓胸、年龄≤45岁患者中诊断价值更大；其最佳临界值的确立可能受诊断标准、结核性胸腔积液性质因素的影响。

Objective To investigate the value of adenosine deaminase（ ADA） for the diagnosis of tubercu-lous pleural effusion.Methods A retrospective analysis was made of 324 cases of tuberculous pleural effusion patients which were effective treated and 68 cases were diagnosed of malignant pleural effusion.By drawing receiver operating characteristic curve, the best threshold of diagnosing of tuberculous pleural effusion was determined,and the distribution characteristics of ADA in tuberculous pleural effusion were analyzed.Results When the ADA was set at 19.5U/L it was good for identifying tuberculous empyema and tuberculous pleurisy.The activity of ADA in group of different gender did not have significant difference（Z=-0.572,P=0.283）.The activity of ADA had significant difference between tuberculous empyema with tuberculous pleurisy patients（Z=-2.317,P=0.01）,and the same as in group of different ages between less than or equal to 45 years old with the others（Z=-2.387,P=0.008）.The activity of ADA had significant difference between tuberculous empyema and tuberculous pleurisy patients of younger than 45 years old（Z=-2.740,P=0.003）,but not in the group of less than or equal to 45 years old （Z=-0.267, P=0.390）.Conclusion The activity of ADA is good for identifying diagnosis of tuberculous pleural effusion and malignant pleural effusion, especially in tuberculous empyema and less than or equal to 45 years old patients.The standard of diagnosis and the nature of the tuberculous pleural effusion may affect the cut-off value of ADA.