同型半胱氨酸在良恶性胸腔积液鉴别诊断中的价值

Value of homocysteine in the differential diagnosis of benign and malignant pleural effusion

目的探讨同型半胱氨酸（Hcy）在良恶性胸腔积液鉴别诊断中的价值。方法选取2010年9月-2012年12月本院收治的140例胸腔积液患者作为研究对象,根据细胞学检测结果分为恶性组（n=57）、炎性组（n=43）和结核组（n=40）,比较各组胸腔积液和血浆中的Hcy水平,通过受试者工作（ROC）曲线下的面积评价其诊断价值,并确定最佳诊断临界值及其灵敏度、特异度和Youden指数。结果恶性组胸腔积液、血浆的Hcy浓度显著高于炎性组和结核组,差异有统计学意义（P〈0.05）。炎性组和结核组胸腔积液、血浆的Hcy浓度比较,差异无统计学意义（P〉0.05）。诊断为恶性胸腔积液时,胸腔积液、血浆的Hcy浓度ROC曲线下面积分别为0.841、0.796,胸腔积液Hcy浓度≥15.8μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.895、0.916、0.810;血浆Hcy浓度≥14.5μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.860、0.904、0.763,两者联合检测时的灵敏度、特异度及Youden指数分别为0.912、0.928、0.840,高于单个检测。诊断为炎性胸腔积液时,胸腔积液、血浆的Hcy浓度ROC曲线下面积分别为0.732、0.672,胸腔积液Hcy浓度≤13.2μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.837、0.866、0.703;血浆Hcy浓度≤12.0μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.814、0.825、0.639,两者联合检测时的灵敏度、特异度及Youden指数分别为0.860、0.887、0.747,高于单个检测。诊断为结核性胸腔积液时,胸腔积液、血浆的Hcy浓度ROC曲线下面积分别为0.760、0.682,胸腔积液Hcy浓度≤10.2μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.850、0.880、0.730;血浆Hcy浓度≤9.7μmol/L时诊断价值最高,灵敏度、特异度及Youden指数分别为0.800、0.860、0.660,两者联合检测时的灵敏度、特异度及Youden指数分别为0.875、0.900、0.775,高于单个检测。结论 Hcy在良恶性胸腔积液鉴别诊断中具有一定的价值,联合检测胸腔积液和血浆的Hcy水平可提高检出率,且对恶性胸腔积液的诊断价值高于炎性和结核性胸腔积液。

Objective To explore the value of homocysteine（Hcy） in the differential diagnosis of benign and malignant pleural effusion. Methods 140 patients with pleural effusion from September 2010 to December 2012 in our hospital were selected and divided into the malignant group（n=57）,the inflammatory group（n=43）,the tuberculosis group（n=40）according to the cytology test results.The Hcy level of pleural effusion and plasma was compared among three groups.The area under the receiver operating characteristic（ROC） curve was performed to evaluate the diagnostic value,and the best critical value and its sensitivity,specificity and Youden index was determined. Results The Hcy level of pleural effusion and plasma in the malignant group was higher than that in the inflammatory group and the tuberculosis group,with significant difference（P〈0.05）.There was no significant difference in the Hcy level of pleural effusion and plasma between the inflammatory group and the tuberculosis group（P〉0.05）.The area under the ROC curve of Hcy level of pleural effusion and plasma in the diagnosis of malignant pleural effusion was 0.841 and 0.796.The Hcy level of pleural effusion more than or equal to 15.8 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden indexwas 0.895,0.916,0.810 respectively.The Hcy level ofplasma more than or equal to 14.5 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden index was0.860,0.904,0.763 respectively.The sensitivity,specificity and Youden index of combined detection was 0.912,0.928,0.840,which was better than that a single detection.The area under the ROC curve of Hcy level of pleural effusion and plasma in the diagnosis of inflammatory pleural effusion was 0.732 and 0.672.The Hcy level of pleural effusion more than or equal to 13.2 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden index was 0.837,0.866,0.703 raspectively.The Hcy level of plasma more than or equal to 12.0 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden index was 0.814,0.825,0.639 respectively.Tthe sensitivity,specificity and Youden index of combined detection was 0.860,0.887,0.747,which was better than that a single detection.The area under the ROC curve of Hcy level of pleural effusion and plasma in the diagnosis of tuberculosis pleural effusion was 0.760 and 0.682.The Hcy level of pleural effusion more than or equal to 10.2 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden index was 0.850,0.880,0.730 respectively.The Hcy level of plasma more than or equal to 9.7 μmol/L had the best diagnostic value and its sensitivity,specificity,Youden index was 0.800,0.860,0.660 respectively.The sensitivity,specificity and Youden index of combined detection was 0.875,0.900,0.775,which was better than that a single detection. Conclusion Hcy has a certain value in the differential diagnosis of benign and malignant pleural effusion.The combined detection of Hcy level of pleural effusion and plasma can improve the detection rate.The diagnostic value of Hcy in the malignant pleural effusion is superior to that in inflammatory and tuberculosis pleural effusion.