多指标联合检测在胸腹水鉴别诊断中的临床价值研究

Clinical value of multi indexes combination in differential diagnosis of hydrothorax and ascites

目的探讨多指标联合检测在胸腹水鉴别诊断中的临床价值研究。方法选取本院住院患者606例,其中胸水461例,腹水145例,统计分析患者胸腹水作总蛋白(TP)、腺苷脱氨酶(ADA)、葡萄糖(GLU)、乳酸脱氢酶(LDH)、氯离子(CL)、C-反应蛋白(CRP)检测和李凡他试验等,分析其诊断价值。结果结核性胸水组TP、ADA、CRP、李凡他试验阳性率、单核细胞百分比和绝对值均显著高于其他原因的胸水(P均<0.05),恶性胸水血性比例显著高于其他组(P<0.05)。恶性腹水的TP、ADA、LDH、CRP、李凡他阳性率、血性比例均显著高于一般性腹水(P均<0.05),而葡萄糖水平显著低于一般性腹水,上述差异均有统计学意义(P<0.05)。ROC曲线显示多指标联合应用可以显著提高诊断效率(AUC达到0.946),单项检测价值有限。结论多个常用实验室指标对胸腹水的鉴别诊断具有较好的价值,特别是通过多指标的联合应用可以显著提高结核性胸水的诊断效率。

Objective To explore the clinical value of multi indexes combination in differential diagnosis of hydrothorax and ascites. Methods 606 cases of hospitalized patients were selected,including 461 cases of hydrothorax and 145 cases of ascites. The total protein（ TP）,adenosine deaminase（ ADA）,glucose（ GLU）,lactate dehydrogenase（ LDH）,chloride（ CL）,C reactive protein（ CRP） and Li van test of hydrothorax in ascites patients were detected or performed for statistically analysis,and its diagnostic value was discussed. Results The positive rates of TP,ADA,CRP,and Li van Test,and the percentage and absolute value of mononuclear cells of hydrothorax group were significantly higher than other causes to hydrothorax（ all P 〈0. 05）,and the proportion of malignant hydrothorax was significantly higher than that of other groups（ P 〈 0. 05）. The positive rates of TP,ADA,CRP,and Li van Test,and the bloody ratio in malignant ascites were significantly higher than those in general ascites（ all P 〈 0. 05）,while the glucose level was significantly lower than that in general ascites,with the differences statistically significant（ P 〈 0. 05）. ROC curve showed that combined application of multiple indicators could significantly improve the diagnostic efficiency（ AUC reached 0. 946）,but the value of single detection was limited. Conclusion Several common laboratory indexes are of good value for the differential diagnosis of hydrothorax and ascites,especially,the combined use of multiple indicators can significantly improve the diagnostic efficiency of tuberculous hydrothorax.