不同诊断方法对结核性胸膜炎诊断价值对比

A Comparative Study of Various Diagnostic Procedures in Patients with Tuberculous Pleurisy

目的探讨闭式胸膜活检联合腺苷脱氨酶以及其他检查指标与胸腔镜诊断效率的在临床应用中的诊断价值比较。方法该研究方便选取了2013年8月—2015年8月收治的85例符合渗出液性质且胸水性质不明确的患者,分别对比了支气管刷检、胸水生化指标、闭式胸膜活检以及胸腔镜检查在结核性胸膜炎的诊断意义。结果有67例患者确诊为结核性胸膜炎,18例患者确诊为恶性肿瘤;胸水ADA≥45 U/L诊断结核的敏感性为85.1%,特异性为77.8%;闭式胸膜活检敏感性为55.2%,特异性100.0%;而胸腔镜检查敏感性以及特异性分别为91.0%以及100.0%;然而闭式胸膜活检联合胸水ADA≥45U/L以及胸水淋巴细胞中性粒细胞比值≥0.75的敏感性达到77.6%,特异性为100.0%。结论闭式胸膜活检联合胸水ADA以及胸水淋巴细胞中性粒细胞比值在结核性胸膜炎患者中有很高的诊断价值。该联合检查方法是相对无创、经济的且且有较高的诊断价值。

Objective To compare th e d iag n os tic v alu e of closed p leu ra l biopsy combined with ad eno sine d eam ina se and other indicators in the diagnosis of thoracoscopy. Methods Altogether, 85 p a t ien ts with u nd iagn osed exu da tiv e p leu ra l effu-sions between August 2013 to August 2015 were recrui ted for a prospective, direct comparison between bronchial wash, pleural fluid microbiology and biochemis try （adenos ine deaminase （ADA） and cel l count）, closed needle biopsy, and medical thoracoscopy. Results The fin a l d iagnosis was tu b erculou s p leu risy in 67 p a t ien ts , mal ig nancy in 18 p a tien ts . P le u ra l fluid ADA of 逸 45 U/L was 8 5.1% sen sit iv e an d 7 7 .8% specific. S ensi tivity of closed n e e d le biopsy an d med ic al thoracoscopy was 55.2% and 91.0%,respect ively. Both were 100.0% specific. Combined ADA, lymphocyte/neutrophi l ratio of逸0.7 5 plus closed needle biopsy reached 77.6% sensit ivity and 100.0% specif ici ty. Conclusion A comb in ation of p leu ra l fluid ad e n o -s ine deaminase, different ial cel l count and closed needle biopsy has a high diagnos tic accuracy in undiagnosed exudative pleural effusions. This combined method is relatively noninvasive, economic, and has an important value in the diagnosis of tuberculous pleurisy.