多指标联合检测对结核性与肺癌性胸腔积液的鉴别诊断价值

The value of detecting multi-indicators in distinguishing pleurisy effusions with tuberculosis and lung cancer

目的评估胸腔积液中的白细胞数(WBC)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、癌胚抗原(P-CEA)和血清中的铁蛋白(FRT)、糖类抗原CA50、糖类抗原CA125、癌胚抗原(S-CEA)以及全血结核感染T细胞斑点试验(TSPOT.TB)在鉴别结核性胸腔积液(tuberculous pleural effusion,TPE)与肺癌性胸腔积液(malignant pleural effusion of lung cancer,LC-MPE)中的应用价值,以期筛选最优的鉴别诊断模型。方法选取临床确诊的82例TPE患者和120例LC-MPE患者的胸腔积液和血液进行上述指标的检测并用ROC曲线分析以确定单项检测以及联合检测的诊断性能。结果 LC-MPE组的P-CEA、CA50、CA125和S-CEA水平均高于TPE组(P<0.05),TPE组的WBC、ADA和T-SPOT.TB水平均高于LC-MPE组(P<0.05);ROC曲线表明:ADA、P-CEA、S-CEA和T-SPOT.TB水平对TPE和LC-MPE的鉴别诊断均具有一定的价值;多指标联合分析提示:ADA和P-CEA联合模式(AUC=0.980)与ADA、P-CEA、S-CEA和T-SPOT.TB四项指标联合模式(AUC=0.988)具有更高的诊断价值。结论 ADA、P-CEA、S-CEA和T-SPOT.TB表达水平对TPE和LC-MPE的鉴别诊断均具有一定的价值;而ADA和P-CEA联合模式与ADA、P-CEA、S-CEA和T-SPOT.TB联合模式可作为鉴别两种疾病较好的诊断模型。

Objective To assesse the clinical diagnostic value of pleural effusion WBC,lactate dehydrogenase（LDH）,adenosine deaminase（ADA）,carcinoembryonic antigen（P-CEA）combined with serum ferritin（FRT）,carbohydrate antigen 50（CA50）,carbohydrate antigen 125（CA125）,carcinoembryonic antigen（S-CEA）and T cell spot test of TB infection（T-SPOT.TB）in distinguishing tuberculous pleural effusion（TPE）and malignant pleural effusion of lung cancer（LC-MPE）and acquire the optimal diagnostic model.Methods To selecte 82 patients of TPE and 120 patients of LC-MPE in this study.The levels of those indexes in the pleural effusion and serum were detected and analyzed by ROC curves to confirm the Diagnostic performance of single and conbined indexes.Results The levels of P-CEA,CA50,CA125 and S-CEA in LC-MPE were significantly higher than TPE（P〈0.05）.The levels of WBC,ADA and T-SPOT.TB in TPE were significantly higher than LC-MPE（P〈0.05）;It was suggested by ROC curves that there were diagnostic value of ADA,P-CEA,S-CEA and T-SPOT.TB for distinguishing TPE and LC-MPE;Multi-factor analysis showed that the combined detection model of indicators of ADA and P-CEA（AUC=0.980）and ADA,P-CEA,S-CEA and T-SPOT.TB（AUC=0.988）were better than alone and other combined detection models.Conclusion The expression levels of ADA,P-CEA,S-CEA and T-SPOT.TB all have certain value in distinguishing TPE and LC-MPE,whereas the diagnostic efficacy of combined model of ADA,P-CEA,S-CEA and T-SPOT.TB was superior to other diagnostic models.