胸腔积液ADA、CEA、PCT联合检测对结核性和恶性胸腔积液的诊断价值

Diagnostic value of combined detection of ADA, CEA and PCT in pleural effusion for tuberculous and malignant pleural effusion

目的探讨联合检测胸腔积液降钙素原(PCT)、腺苷脱氨酶(ADA)、癌胚抗原(CEA)对结核性和恶性胸腔积液的诊断价值。方法 40例胸腔积液患者,根据胸腔积液性质不同分为结核组(结核性胸腔积液,13例)、恶性组(恶性胸积液,14例)和对照组(单纯心力衰竭引起的胸腔积液,13例)。比较三组患者胸腔积液的PCT、CEA、ADA水平,分析PCT、ADA、CEA及三项指标联合检测对结核性和恶性胸腔积液的诊断敏感性、特异性。结果结核组胸腔积液中PCT、ADA水平均明显高于对照组和恶性组,差异具有统计学意义(P<0.05)。恶性组胸腔积液中CEA水平高于结核组和对照组,差异具有统计学意义(P<0.05)。胸腔积液中ADA、PCT对结核性胸腔积液诊断的敏感性分别为84.6%、84.6%,特异性为85.2%、85.2%;CEA对恶性胸腔积液的诊断敏感性为71.4%,特异性为92.3%。三项指标联合检测敏感性为88.9%,特异性为100.0%。结论联合检测胸腔积液中CEA、PCT与ADA可极大提高结核性和恶性胸腔积液诊断的敏感性和特异性。

Objective To investigate the diagnostic value of combined detection of procalcitonin（PCT）, adenosine deaminase（ADA） and carcinoembryonic antigen（CEA） in pleural effusion for tuberculous and malignant pleural effusion. Methods According to the different properties of pleural effusion, 40 patients with pleural effusion were divided into tuberculosis group（tuberculous pleural effusion, n=13）, malignant group（malignant pleural effusion, n=14） and control group（pleural effusion caused by simple heart failure, n=13）. In each group, the levels of PCT, CEA and ADA in pleural effusion were compared. The diagnostic sensitivity and specificity of PCT, ADA, CEA and combined detection of three indicators for tuberculous and malignant pleural effusion were analyzed. Results The levels of PCT and ADA in tuberculosis group were significantly higher than those in control group and malignant group, the differences were statistically significant（P〈0.05）. The CEA level of the differences were statistically significant pleural effusion in malignant group was significantly higher than tuberculous group and control group, the differences were statistically significant（P〈0.05）.The diagnostic sensitivity of ADA and PCT in pleural effusion for tuberculous pleural effusion were 84.6%, 84.6% respectively, the specificity were 85.2%, 85.2%. The diagnostic sensitivity of CEA for malignant pleural effusion was 71.4%,and specificity was 92.3%. The sensitivity and specificity of combined detection of three indicators were 88.9% and 100.0% respectively. Conclusion The combined detection of CEA, PCT and ADA in pleural effusion can greatly improve the sensitivity and specificity of the diagnosis of tuberculous and malignant pleural effusion.