多指标联合检测在胸腹水鉴别诊断中临床价值研究

Clinical value of multiple indicators combined in differential diagnosis of pleural and ascites

目的:比较常规胸腹水检验指标在不同原因胸腹水患者中的表达水平差异,并探讨其鉴别诊断价值。方法:选取2013-10—2017-04住院患者606例,其中胸水461例(分为一般性胸水组176例,恶性胸水组152例,结核性胸水组133例),腹水145例(分为一般性腹水组80例,恶性腹水组63例,结核性腹水组2例),对所有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、细胞计数及分类等,并对检测结果进行统计学分析。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组(均P<0.05),恶性胸水组血性比例显著高于其他组(P<0.05)。恶性腹水组TP、ADA、LDH、CRP、李凡他阳性率、血性比例均显著高于一般性腹水(均P<0.05),而GLU水平显著低于一般性腹水(P<0.05)。ROC曲线显示包括ADA在内的多个指标可以用于鉴别诊断结核性胸水[ROC曲线下面积(AUC)均大于0.70],多指标的联合应用可以显著提高诊断效率(AUC达到0.946);而TP、LDH和CRP可用于鉴别诊断恶性腹水和一般性腹水,但单项和联合检测均价值有限(AUC仅稍大于0.70)。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 compare the difference of routine marker expression level in patients with different causes of hydrothorax and ascites,and to explore the value of differential diagnosis.Method：606 cases of hospitalized patients in Yingshan People＇s Hospital from October 2013 to April 2017 were enrolled,including 461 cases of hydrothorax（176 cases of general pleural effusion,152 cases of malignant pleural effusion,133 cases of tuberculous pleural effusion）and 145 cases of ascites（80 cases of general ascites,63 cases of malignant ascites,2 cases of tuberculous ascites）.For the samples of hydrothorax and ascites,total protein（TP）,adenosine deaminase（ADA）,glucose（GLU）,lactate dehydrogenase（LDH）,chloride（CL）and C reactive protein（CRP）were detected,and Rivalta test,cell counting and classification were made.The test results were statistically analyzed.Result：The level of TP,ADA,CRP,positive rate of Rivalta test and percentage and absolute counting of mononuclear cells in tuberculous pleural effusion group were significantly higher than those in other groups（all P〈0.05）,and the proportion of bloody pleural effusion in patients with malignant pleural effusion was significantly higher than that in other groups（P〈0.05）.The level of TP,ADA,LDH,CRP and positive rate of Rivalta test in malignant ascites were significantly higher than those in general ascites（all P〈0.05）,while glucose level was significantly lower than that in general ascites（P〈0.05）.The ROC curve showed a number of indicators including ADA could be used for differential diagnosis of tuberculous pleural effusion[The area under ROC curve（AUC）more than 0.70],and combined use with multi index could significantly improve the diagnostic efficiency（AUC was 0.946）;while TP,LDH and CRP could be used for differential diagnosis of malignant ascites and general ascites,but single and combined use of different indicators were of limited value（AUC only slightly more than 0.70）.Conclusion：Several commonly used laboratory indicators are valuable for differential diagnosis of pleural and ascitic fluid,especially through the combined application of multiple indicators,which can significantly improve the diagnostic efficiency of tuberculous pleural effusion.