胸腔积液腺苷脱氨酶对内科胸腔镜检查临床病例选择的意义

Clinical significance of adenosine deaminase in selection patient for medical thoracoscopy

目的探讨胸腔积液腺苷脱氨酶（ADA）对内科胸腔镜检查临床病例选择的意义。方法回顾性分析2013年1月至2016年4月经内科胸腔镜检查的不明原因胸腔积液患者198例，分为青年组、中年组和老年组，以胸腔积液ADA≥45U／L或ADA≥45U／L联合淋巴细胞占白细胞比例≥50％作为诊断结核性胸膜炎的标准，确定其敏感度和特异度，并分析性别、年龄对ADA的影响。结果内科胸腔镜对不明原因胸腔积液的诊断率为98．9％。胸腔积液ADA≥45U／L诊断结核性胸膜炎的敏感度68．7％，特异度88．1％；胸腔积液ADA≥45U／L联合淋巴细胞占白细胞比例≥50％诊断结核性胸膜炎的敏感度70．2％，特异度96．3％，尤其是在青年组，其诊断特异度达100％。结论对于不明原因胸腔积液的青年患者，如果胸腔积液ADA≥45U／L且淋巴细胞占白细胞比例≥50％，可考虑诊断性抗结核治疗；对中老年不明原因胸腔积液，建议常规行内科胸腔镜检查，避免误诊。

Objective To evaluate clinical significance of adenosine deaminase （ADA） in selection patient for medical thoracoscopy. Methods A retrospective analysis of January 2013 to April 2016, 198 cases unexplained pleural effusion patients were divided into youth group, middle-aged and elderly groups. To determine the sensitivity and specificity of ADAm45 U/L or ADAm45 U/L combine percentage of lymphocytes in white blood cells ≥50% as the diagnosis criteria of tuberculous pleurisy, and analysis gender and age influence on ADA. Results The diagnosis of medical thoracoscopy in unexplained pleural effusion was 98.9%. The sensitivity and specificity of ADAm45 U/L in diagnosis of tuberculous pleurisy were 73.3% and 89.2%;The sensitivity and specificity of ADA ≥45 U/L combine percentage of lymphocytes in white blood cells≥50% in diagnosis of tuberculous pleurisy were 71% and 98.5%. Especially in youth group, the sensitivity and specificity of ADA ≥45 U/L combine percentage of lymphoeytes in white blood cells≥50% in diagnosis of tuberculous pleurisy was 100%. Conclusions If young patients have typical clinical manifestations of tuberculous pleurisy and ADA≥45 U/L percentage of lymphocytes in white blood cells ≥50% in pleural effusion, anti-TB treatment without further thoracoscopy is appropriate; For middle aged and elderly patients of unexplained pleural liquid, thoracoscopy is recommended to avoid misdiagnosis.