胸腔积液行γ-干扰素诱导蛋白10及腺苷脱氨酶检测的诊断价值

Diagnostic value of IP-10 and ADA in pleural effusion

目的评价人r干扰素诱导蛋白10（IP-10）、腺苷脱氨酶（ADA）单独检测及两者联合检测对结核性胸腔积液和恶性胸腔积液的鉴别诊断价值，分析结核性胸膜炎患者胸腔积液中IP-10与ADA含量的相关性。方法收集2016年4月至2017年4月收治于贵阳市公共卫生救治中心的胸腔积液患者138例，其中临床诊断及确诊为结核性胸膜炎的患者85例（结核性胸腔积液组），确诊为恶性胸腔积液的患者53例（恶性胸腔积液组）。通过绘制ROC曲线，确定IP-10、ADA检测鉴别结核性胸腔积液与恶性胸腔积液的最佳临界值，分析IP-10联合ADA检测对于诊断结核性胸膜炎的临床诊断效能。结果结核性胸腔积液组患者胸腔积液中检测到的IP-10、ADA浓度[中位数（四分位数）]分别为51．61（39．64，91．08）pg／ml、46．10（34．90，58．25）U／L，明显高于恶性胸腔积液组[分别为21．96（15．72，30．18）pg／ml、7．40（5．80，12．35）U／L]，差异均有统计学意义（Z=8．52，P〈0．001；Z=9．69，P〈0．001）。通过绘制ROC曲线，确定IP-10鉴别结核性胸腔积液与恶性胸腔积液的诊断最佳临界值为32．15pg／ml，敏感度和特异度分别为82．4％（70／85）和83．0％（44／53）；ADA鉴别结核性胸腔积液与恶性胸腔积液的诊断最佳临界值为28．6U／L，敏感度和特异度分别为91．8％（78／85）和98．1％（52／53）。胸腔积液中IP-10与ADA含量呈明显的正相关性（r=0．73，P〈0．001）。两者联合检测的敏感度（95．3％，81／85）较单独检测IP-10（82．4％，70／85）明显升高，差异有统计学意义（χ^2=7．17，P=0．007），特异度（81．1％，43／53）较单独检测IP10（83．0％，44／53）略有降低，但差异无统计学意义（χ^2=0．06，P=0．800）；两者联合检测的敏感度（95．3％，81／85）较单独检测ADA（91．8％，78／85）略有升高，但差异无统计学意义（χ^2=0．88，P=0．350），特异度（81．1％，43／53）较单独检测ADA（98．1％，52／53）明显降低，差异有统计学意义（χ^2=8．22，P=0．004）。结论胸腔积液中IP-10、ADA对结核性胸膜炎的诊断均有较高价值；两者联合检测的敏感度优于单独检测IP-10，而特异度低于单独检测ADA。胸腔积液中IP-10与ADA含量呈明显的正相关性。

Objective To explore the value of differential diagnosis for tuberculous pleural effusion and ma- lignant pleural effusion human interferon gamma inducible protein 10 （IP-10） and adenosine deaminase （ADA） alone and their combined detection in tuberculous and malignant pleural effusion, and to analyze the correlation between the level of IP10 and ADA in tuberculous pleural effusion. Methods One hundred and thirty-eight cases with pleural effusion admitted in Guiyang Public Health Clinical Center were enrolled and divided into tuberculous pleural effusion in 85 eases （as tuberculous pleural effusion group） and malignant pleural effusion in 53 cases （as malignant pleural effusion group） according to composite reference standard and/or gold standard during Apr. 2016 to Apr. 2017. The cut-off values of IP-10 and ADA were determined for differential diagnosis between tuberculous and malignant pleural effusion using receiver operating characteristics curve. IP-10 combined with ADA detection was evaluated for diagnostic efficiency in diagnosis of tuberculous pleurisy. Results The levels of IP-10 and ADA detected in tuberculous pleural effusion group （51.61（39.64, 91.08） pg/ml for IP-10; 46.10 （34.90, 58.25） U/L for ADA） were higher than those in malignant pleural effusion group （21.96 （15.72, 30.18） pg/ml for IP-10; 7.40 （5.80, 12.35） U/L for ADA） with significant differences statistically （Z=--8. 52, P-0. 001; Z=--9.69, P% 0. 001）. By drawing ROC curve, the cut-off value, sensitivity and specificity were 32.15 pg/ml, 82.4% （70/85） and 83.0% （44/53） for IP-10, and 28.6 U/L, 91.8% （75/85） and 98. 1% （52/53） for ADA in the diagnosis and differential diagnosis of tuberculous and malignant pleural effusion, respectively. There was a positive correlation between the level of IP10 and ADA in pleural effusion （r=0. 73, P〈0. 001）. The sensitivity （95.3%, 81/85） of IP-10 combined with ADA detection for pleural fluid was higher than that of IP-10 detection alone （82.4%, 70/85） with significant difference statistically （X2 =7.17, P=0. 007）. The specificity （81.1%, 43/53） of IP10 combined with ADA detection for pleural fluid was lower a little bit than that of IP-10 detection alone （83.0%, 44/53） without significant difference statistically （X2 = 0.06, P = 0. 800）. The sensitivity （95.3%, 81/85） of IP-10 combined with ADA detection for pleural fluid was higher a little bit than that （91.8G, 78/85） of ADA detection alone without significant difference statistically （χ^2=0.88, P=0. 350）. However, the specificity （81.1%, 43/53） of IP-10 combined with ADA detection for pleural fluid was lower than that （98.1%, 52/53） of ADA detection alone with significant difference statistically （χ^2= 8. 22, P = 0. 004）. Conclusion Pleural fluid IP-10 and ADA from pleural effusion has high value in diagnosis of tuberculous pleurisy. It is a significant positive correlation between IP-10 and ADA. The sensitivity of their combined detection has better than that of IP-10 alone, and the specificity of their combined detection has lower than that of ADA alone. There is a positive correlation between the level of IP-10 and ADA in pleural effusion.