IFN-γ、IP-10、MCP-1用于诊断结核性胸膜炎的临床价值分析

Clinical value of IFN-γ,IP-10 and MCP-1 in the diagnosis of tuberculous pleurisy

目的探讨胸腔积液中γ-干扰素(IFN-γ)、γ-干扰素诱导蛋白10(IP-10)、单核细胞趋化蛋白-1(MCP-1)用于诊断结核性胸膜炎的临床价值。方法选取2016年2月-2017年2月我院收治的92例发热、胸痛及胸腔积液患者为研究对象,其中确诊为结核性胸膜炎者60例,非结核性胸膜炎者32例,采用酶联免疫吸附试验(ELISA)检测所有受试者胸腔积液中IFN-γ、IP-10、MCP-1水平,绘制ROC曲线,评价IFN-γ、IP-10、MCP-1诊断结核性胸膜炎效能。结果结核性胸膜炎组胸腔积液中IFN-γ、IP-10、MCP-1水平分别为337.56±85.16 pg·m L^(-1)、279.25±62.32 pg·m L^(-1)、805.25±207.10 pg·m L^(-1),明显高于非结核性胸膜炎组胸水中IFN-γ、IP-10、MCP-1水平73.58±23.15 pg·m L^(-1)、92.56±30.38 pg·m L^(-1)、243.31±58.22 pg·m L^(-1),差异有统计学意义(P<0.05)。以结核性胸膜炎组为阳性组,以非结核性胸膜炎组为阴性组,绘制ROC曲线可得,胸腔积液IFN-γ、IP-10、MCP-1检测最佳临界值分别为146.59 pg·m L^(-1)、160.37 pg·m L^(-1)、497.24 pg·m L^(-1)。胸腔积液IFN-γ诊断结核性胸膜炎敏感性为84.37%,特异性为70.65%,准确性为77.96%;胸腔积液IP-10诊断结核性胸膜炎敏感性为72.37%,特异性为76.02%,准确性为73.86%;胸腔积液MCP-1诊断结核性胸膜炎敏感性为90.40%,特异性为96.85%,准确性为94.02%。结论检测胸腔积液中IFN-γ、IP-10、MCP-1水平可辅助结核性胸膜炎诊断,且MCP-1诊断敏感度及特异度最高,值得临床推广。

Objective To investigate the clinical value of IFN-γ,IP-10 and MCP-1 in the diagnosis of tuberculous pleurisy. Methods From February 2016 to February 2017,92 cases of fever,chest pain and pleural effusion patients as the object of study,including 60 cases of tuberculous pleurisy confirmed,and 32 cases of non-tuberculous pleurisy. The levels of IFN-γ,IP-10 and MCP-1 in pleural effusion were measured by ELISA. It used IFN-γ,IP-10 and MCP-1 to determine the critical value of tuberculous pleurisy by ROC curve,and the diagnostic efficacy was evaluated. Results The levels of IFN-γ,IP-10 and MCP-1 in pleural effusion of tuberculous pleurisy were337. 56 ± 85. 16 pg·m L^（-1）,279. 25 ± 62. 32 pg·m L^（-1） and 805. 25 ± 207. 10 pg·m L^（-1） pg·m L^（-1）,which were significantly higher than those in the non-tuberculous pleurisy group（ 73. 58 ± 23. 15 pg·m L^（-1）,92. 56 ± 30. 38 pg·m L^（-1）,243. 31 ± 58. 22 pg·m L^（-1））（ P 0. 05）. The optimal thresholds of IFN-γ,IP-10 and MCP-1 were146. 59 pg· m L^（-1）,160. 37 pg · m L^（-1）,and 497. 24 pg · m L^（-1）. The sensitivity of pleural effusion IFN-γ was84. 37%,the specificity was 70. 65% and the accuracy was 77. 96%. The sensitivity of pleural effusion IP-10 was72. 37%,the specificity was 76. 02% and the accuracy was 73. 86%. The sensitivity of pleural effusion MCP-1 was90. 40%,the specificity was 96. 85% and the accuracy was 94. 02%. Conclusion The detection of IFN-γ,IP-10 and MCP-1 in pleural effusion can assist in the diagnosis of tuberculous pleurisy,and the sensitivity and specificity of MCP-1 diagnosis are the highest.