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胸水ADA联合胸水ADA/血清ADA在结核性胸膜炎中的诊断价值

The Diagnostic Efficacy of Adenosine Deaminase(ADA) and PADA/SADA in Patients with Pleural Tuberculosis
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摘要 目的探讨胸水ADA联合胸水ADA/血清ADA在结核性胸膜炎中的诊断价值。方法选取2005年至今303例不明原因胸腔积液患者,均经内科胸腔镜胸膜活检明确诊断。住院间留取胸水及血液标本,分别记录全部患者的腺苷脱氨酶(ADA)数值,计算胸水ADA/血ADA。运用受试者工作曲线(ROC)分析其最佳诊断界值及相关的灵敏度及特异度。结果全部303例患者中,结核性胸腔积液139例(45.87%),恶性胸腔积液144例(47.53%),肝源性3例(0.99%),心源性2例(0.66%),肾源性2例(0.66%),肺炎旁7例(2.31%),脓胸3例(0.99%),结节病2例(0.66%),嗜酸细胞浸润性肺疾病1例(0.33%)。其中结核组男90例,女49例,平均年龄47.4±22.0(x±s)。非结核组(肿瘤:男71例,女73例;非肿瘤:男13例,女7例)平均年龄63.2±12.2(x±s)。胸水ADA曲线下面积为0.918,取界值为28.69 U/L时,其诊断灵敏度为88.5%,特异度为88.4%。PADA/SADA曲线下面积为0.85,取界值在2.05时,其诊断灵敏度为86.3%,特异度为72.6%。血清ADA曲线下面积为0.703,对诊断的参考价值不大。当胸水ADA与PADA/SAD联合时,诊断的灵敏度为84.2%,特异度为89%。结论胸水腺苷脱氨酶检查在结核性胸膜炎诊断中的价值值得肯定,当其取界值在28.69 U/L时有良好的诊断价值。血清ADA对结核性胸膜炎的临床诊断价值不大。以PADA/SADA 2.05为诊断界值对于结核性胸膜炎的判断具有一定的价值。两者联合对于结核性胸膜炎的诊断具有一定的前景。 Objective To assess the diagnostic efficacy of adenosine deaminase(ADA) and PADA/SADA in patients with pleural tuberculosis. Methods We analysed 303 patients with unexplained pleural effusion diagnosed with medical thoracoscopy by pleural biopsy in our hospital since 2005. The samples of blood and pleural effusion,the values of ADA and the ratio of pleural ADA(PADA) and serum ADA(SADA)(PADA/SADA ratio) were obtained during their hospitalization. Receiver operating curve(ROC) was used in the analysis of its best diagnostic cutoff value,sensitivity and specificity. Results Among the 303 patients,139 cases of tuberculous pleural effusion(45. 87%),144 cases of malignant pleural effusion(47. 53%),3 cases of hepatic(0. 99%),2 cases of cardiogenic(0. 66%),2 cases of nephrogenic(0. 66%),7 cases of pneumonia(2. 31%),3 cases of empyema(0. 99%),2 cases of sarcoidosis(0. 66%),eosinophil infiltration of lung disease in 1 cases(0. 33%). Among them,tuberculous group(90 males and 49 females)with an average age of 47. 4 ± 22(x± s). Non-tuberculous group(tumor: 71 males,73 females; non tumor: 13 males and 7 females) with an average age of 63. 2 ± 12. 2(x± s). We analyzed the pleural and SADA of TB group and non-TB group. Through ROC,the area under curve(AUC) of PADA was 0. 918,when took ADA level ≥28. 69 IU as cutoff level to identify individuals in the TB group,the sensitivity was 88. 5% and specificity was 88. 4%. PADA/SADA ratio showed an AUC of 0. 85,a sensitivity of 86. 3% and a specificity of 72. 6% was obtained when the cutoff value was2. 05. The AUC of serum ADA was 0. 703. combining the PADA with PADA/SADA ratio to evaluate the patients,the sensitivity and specificity would be 84. 2% and 89%,respectively. Conclusions The value of PADA in pleural tuberculosis is obvious; PADA/SADA ratio is also useful in the diagnosis; in combination with the former parameters,a better accurate diagnostic rate could be expected; the SADA alone is of less importance in making diagnosis.
作者 张新军 陈济超 ZHANG Xinjun;CHEN Jichao(Space Center Hospit)
机构地区 航天中心医院
出处 《航空航天医学杂志》 2018年第6期647-650,共4页 Journal of Aerospace medicine
关键词 结核性胸膜炎 腺苷脱氨酶 ROC曲线 Pleural tuberculosis adenosine deaminase receiver operating curve
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