CA125在结核病诊断及社区传染病管理中的作用

Value of serum CA125 in diagnosis of tuberculosis and control of spread of infectious diseases in community

目的评价CA125在结核病诊断及判断治疗终点的价值,为结核病社区管理寻找新工具。方法选取2013年8月—2014年8月在深圳市龙岗区第三人民医院确诊为结核病的患者93例为结核病组,同时选取非结核病住院患者93例为对照组,使用化学发光法检测患者血清CA125水平,采用χ2检验比较2组间阳性率结果;对CA125阳性的结核病患者随访6个月,按照临床综合评估分为治愈组及非治愈组,复测血清CA125并评估其对非治愈组的诊断效能。结果结核病组血清CA125阳性率为68.8%(64/93),对照组CA125阳性率为57%(53/93),2组间差异无统计学意义(P>0.05);对64例CA125阳性的结核病患者随访6个月后,临床综合评估分为治愈组46例,非治愈组18例,CA125对非治愈组诊断敏感性为55.5%(10/18),特异性为100%(46/46),阳性预测值为100%(10/10),阴性预测值为85.1%(46/54),准确率为87.5%(56/64)。结论血清CA125对结核病的鉴别诊断价值不大,但对判断治疗终点有较大意义。CA125持续阳性应高度怀疑结核病未治愈,可作为社区传染病管理的随访指标。

Objective To investigate the value of serum CA125 in the diagnosis of tuberculosis and in determining the treatment endpoint,and explore new method for the community management of tuberculosis. Methods Total 93 cases of tuberculosis（ TB group） and 93 cases of non-tuberculosis inpatients（ non-TB group） in our hospital from August 2013 to August 2014 were randomly chosen. The serum CA125 level was tested with chemiluminescence method,and the rate of positive result between the two groups was compared with Chi-square test. The TB patients with a positive CA125 in the TB group were followed up for 6 months and divided into cured group and uncured group according to clinical comprehensive assessment. The CA125 levels were measured again and evaluated its diagnostic efficiency in the uncured group. Results There was no significant statistical difference in rate of CA125 positive result between the original tuberculosis group（ 64 /93,68. 8%） and non-tuberculosis group（ 53 /93,57%）,P〈0. 05. According to the followed-up of TB patients with a positive CA125,46 cases were cured,18 cases were uncured. The diagnostic sensitivity to uncured group was 55%（ 10 /18）,specificity was 100%（ 46 /46）,prediction in positive result was 100%（ 10 /10）,prediction in negative result was 85. 1%（ 46 /54）,and accuracy was 87. 5%（ 56 /64）. Conclusion The serum level of CA125 is of little value in the differential diagnosis of tuberculosis,but is more significant in determining the treatment endpoint. The continued positive results of CA125 tests positive result points highly suspect that is tuberculosis not cured. CA125 can be used in the control of the spread of tuberculosis in community as an test indicator.