单纯结核性胸膜炎与合并尘肺时多项检测指标的差异性分析

Analysis of difference between simple tuberculous pleurisy and when combined with pnemnoconiosis targets

目的观察单纯性结核性胸膜炎与合并尘肺时多项检测指标的差异，为临床诊断治疗提供一定帮助。方法回顾性分析北京京煤集团总医院尘肺与结核病科2010-2013年65例“煤工尘肺合并结核性胸膜炎”患者（简称“尘肺一结核组”）及44例单纯性结核性胸膜炎患者（简称“单纯结核组”），以胸腔积液腺苷脱氨酶（ADA）、胸腔积液ADA／血ADA比值、胸腔积液乳酸脱氢酶（LDH）、胸腔积液LDH／血LDH比值、胸腔积液C反应蛋白（CRP）；胸腔积液结核抗体（TBAb）、病程长短来测定各指标的阳性率及检测结果。采用SPSS13．0统计软件进行统计分析。计量资料两组之间比较，在方差齐性时采用两独立样本t检验，方差不齐时采用t’检验分析；计数资料采取7。检验。以PG0．05为差异有统计学意义。结果（1）尘肺一结核组和单纯结核组ADA、LDH、TBAb检测阳性率及胸腔积液ADA／血ADA、胸腔积液LDH／血LDH比值阳性率分别为：35．4％（23／65）、59．1％（26／44）；46．2％（30／65）、70．5％（31／44）；16．9％（11／65）、40．9％（18／44）；72．3％（47／65）、93．2％（41／44）；76．9％（50／65）、95．5％（42／44）。差异均有统计学意义（x^2值分别为4．99，5．34，6．55，6．07，5．51，P值均〈0．05）。CRP阳性率两组分别为18．5％（12／65）、34．1％（15／44），两组比较差异无统计学意义（x^2=2．52，P〉0．05）。（2）尘肺-结核组和单纯结核组ADA、LDH、病程检测结果，以及胸腔积液ADA／血ADA、胸腔积液LDH／血LDH比值检测结果分别为：（33．52±20．34）、（42．5±18．39）U／L；（132±77．66）、（199±80．99）U／L；（6．58±4．53）、（4．0±2．31）个月；0．94±0．38、1．41±0．42；0．86±0．55、1．25±0．16。差异均有统计学意义（t值分别为2．36，4．34，3．48，5．17，4．56，P值均〈0．05）。CRP两组检测结果分别为（23．9±15．84）mg／L、（25．8±16．85）mg／L，差异无统计学意义（t=0．60，P〉0．05）。结论尘肺一结核组患者中胸腔积液ADA、LDH、TBAb、胸腔积液ADA／血ADA、胸腔积液LDH／血LDH多种指标检测结果低于单纯结核组患者，而病程高于后者，各指标的联合观察结果可能能起到临床辅助诊断作用。

Objective To observe the differences of biomarkers from patients with tuberculous pleurisy and with tuberculous pleurisy combined with pneumoconiosis, in order to improve clinical ability of diagnosis and treat- ment. Methods We analyzed retrospectively multiple biomarkers including adenosine deaminase in pleural effusion （pADA）, pADA/sADA （ADA in serum）, lactate dehydrogenase pleural effusion （pLDH）, pLDH/sLDH （LDH in serum）, C reactive protein in pleural effusion （pCRP）, TB-antibody in pleural effusion （pTB-Ab） and course time tested from 65 cases with tuberculous pleurisy combined with pneumoconiosis （pneumoeoniosis-tuberculosis group） and 44 cases with tuberculous pleurisy （simple tuberculosis group） admitted in Beijing General Hospital of Jingmei Group during 2010 to 2013. Measurement data between the two groups were analyzed using SPSS 13 software. When the variance was homogeneity, two independent samples t test was applied, and when the variance was not homogeneity, tr test was applied. Count data was using Chi square test. The difference was statistically significant with P〈0.05. Results （1） The positive rates of ADA, LDH, TB-Ab, pADA/sADA, pLDH/sLDH were 35.4% （23/65） and 59.1%（26/44）, 46.2% （30/65） and 70.5%（31/44）, 16.9% （11/65） and 40. 9% （18/44）,72.3% （47/65） and 93.2%（41/44）, 76.9% （50/65） and 95.5% （42/44） in pneumoconiosi-tuberculosis group and simple tuberculosis group, respectviley. The differences of biomarkers were significant statistically （x^2=4. 99, 5.34, 6.55, 6.07,5.51, P〈0. 05）. But the difference in positive rate of CRP in two groups were no difference with 18. 5% （12/65） and 34. 1% （15/44） in two groups （x^2 =2.52, P〉0. 055. （2） The values of ADA, LDH, course time, pADA/sADA, and pLDH/sLDH were （33.52±20.34） and （42.5±18.39）U/L, （132±77.66） and （199± 80. 99）U/L, （6. 5824. 53） and （4.02±2.31） months, 0. 94±0.38 and 1. 4120.42,0. 8620.55 and 1.25±0.16 in pneumoconiosis-tubereulosis group and simple tuberculosis group, respectively. The differences of biomarkers were significant statistically （t=2.36,4.34,3.48,5.17,4.56, P〈0.05）. But the difference in the value of CRP in two groups were no difference with （23.92±15.84）rag/L, （25.8±16.85）mg/L in two groups （t=0.60,P〉0.05）. Conclusion Most biomarkers including pADA, pLDH, pTB-Ab, pADA/sADA, and pLDH/sLDH from the pneu- moeoniosis-tubereulosis group are lower than those in the simple tuberculosis group. But the course time in pneumo coniosis-tuberculosis group is longer than that in the simple tuberculosis group. All biomarker combination could be helpful for clinical diagnosis in tuberculous pleurisy combined with pneumoconiosis.