胸腔积液肝素结合蛋白检测对肺炎旁胸腔积液鉴别诊断的临床价值

The differential diagnostic value of pleural effusion heparin-binding protein in parapneumonic effusion

目的探讨胸腔积液肝素结合蛋白（HBP）检测在胸腔积液患者中对肺炎旁胸腔积液（PPE）鉴别诊断的应用价值。方法病例对照研究。收集2018年2至7月在衢州市人民医院住院的189例胸腔积液患者的胸腔积液标本，其中肺炎旁胸腔积液（肺炎组）72例，结核性胸腔积液（结核组）24例，恶性胸腔积液（恶性组）46例，其他原因引起的漏出液（漏出液组）47例。对所有胸腔积液进行常规分析和胸腔积液乳酸脱氢酶（LDH）、胸腔积液腺苷脱氨酶（ADA）、胸腔积液总蛋白（TP）检测，并采用酶联免疫吸附法测定胸腔积液HBP水平。各组总体水平差异采用Kruskal－Wallis H检验，方差齐性多组比较采用单因素方差分析，方差不齐多组比较采用LSD检验，计数资料比较采用卡方检验。绘制ROC曲线评价胸腔积液中HBP、LDH、ADA、TP水平在PPE鉴别诊断中的应用。结果胸腔积液HBP浓度在肺炎组为316.1（99.5，399.8）ng/ml，结核组为64.7（18.6，96.8）ng/ml，恶性组15.2（8.4，33.3）ng/ml，漏出液组14.1（6.5，23.0）ng/ml。肺炎组胸腔积液HBP水平与其他3组之间比较，差异有统计学意义（H＝120.3，P〈0.05）。当cut－off值为64.2 ng/ml时受试者工作特征（ROC）曲线下面积为0.953，灵敏度为88.9%（64/72），特异度为89.7%（105/117），阳性预测值为84.2%（64/76），阴性预测值为92.9%（105/113），总符合率为89.4%（169/189）。结论胸腔积液HBP水平诊断效能高，能较好区分胸腔积液患者的PPE，可能是PPE鉴别诊断的生物标志物。

ObjectiveThe aim of this study was to evaluate the value of pleural effusion heparin-binding protein（HBP）in differential diagnosis of parapneumonic effusion.MethodsCase-control study. The pleural effusion of 189 patients with pleural effusion admitted to Quzhou People′s Hospital from February to July 2018, including parapneumonic effusion （n=72）, tuberculous pleural effusion（n=24）, cases of malignant pleural effusion （n=46） and transudative pleural effusion （n=47） were collected. Routine analysis, lactate dehydrogenase（LDH）, adenosine deaminase （ADA） and total protein（TP）examination of all pleural effusions were performed. The levels of heparin-binding protein in the patients′ pleural fluid were measured by ELISA. The difference in the overall level of each group was determined by One-way ANOVA or LSD test followed by Kruskal-Wallis H test dependence on the homogeneity of variances. The categorical data was analyzed by chi-square test.Receiver operating characteristic （ROC） curve was plotted to evaluate the diagnostic value of heparin-binding protein for parapneumonic effusion.ResultsThe concentration of heparin-binding protein was low in malignant pleural effusion[15.2（8.4, 33.3）ng/ml]and transudative effusion[14.1（6.5, 23.0）ng/ml], but high in parapneumonic effusion[316.1（99.5, 399.8）ng/ml]and tuberculous pleurisy[64.7 （18.6, 96.8） ng/ml]. The heparin-binding protein level in parapneumonic effusion was significantly different from the other three groups （H=120.3, P〈0.05）. The receiver operating characteristic curve analysis for an optimal discrimination between parapneumonic effusion from non-parapneumonic effusion could be performed at a cut-off point of 64.2 ng/ml with area under the curve of 0.953[sensitivity： 88.9%（64/72）, specificity： 89.7%（105/117）, positive predictive value： 84.2%（64/76）, negative predictive value： 92.9%（105/113）].ConclusionsHeparin-binding proteinin pleural fluid is effective to be used to classify parapneumonic effusion samples. The detection of heparin-binding protein in pleural effusion has good sensitivity and specificity. It could be a biomarker for differential diagnosis of parapneumonic effusion.