支气管肺泡灌洗液中乳酸脱氢酶、腺苷脱氨酶和结核抗体在肺结核诊断中应用价值研究

The value of lactate dehydrogenase,adenosine deaminase and tuberculosis antibody in bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis

目的探讨支气管肺泡灌洗液中乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)和结核抗体(TB-Ab)在肺结核诊断中的应用价值。方法选取自2016年3月至2017年3月上海市中医药大学附属第七人民医院收治的70例肺结核患者作为结核组,另选取70例健康体检者作为健康组。比较两组ADA、LDH水平及TB-Ab活性;计算3项指标单独检测和联合检测肺结核的敏感性和特异性。结果结核组LDH、ADA水平均显著高于健康组,两组间比较,差异有统计学意义(P <0. 05)。结核组LDH、ADA及TB-Ab单独检测肺结核的阳性水平均显著高于健康组,两组间比较,差异有统计学意义(P <0. 05)。结核组LDH、ADA及TB-Ab联合检测的阳性率为92. 9%(65/70),显著高于健康组的1. 4%(1/70),两组间比较,差异有统计学意义(P <0. 05)。LDH、ADA及TB-Ab联合检测肺结核的敏感性和特异性分别为92. 9%和98. 6%,均显著高于各指标单独检测的敏感性(78. 6%、81. 4%及85. 7%)和特异性(95. 7%、94. 3%及97. 1%),差异均有统计学意义(P <0. 05)。结论支气管肺泡灌洗液中LDH、ADA及TB-Ab联合检测能显著提高肺结核诊断的敏感性和特异性,可作为早期诊断与鉴别肺结核的重要参考指标。

Objective To investigate the value of lactate dehydrogenase(LDH),adenosine deaminase(ADA)and tuberculosis antibody(TB-Ab)in bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis.Methods A retrospective study was performed on 70 cases of patients with tuberculosis who were admitted from March 2016 to March 2017,another 70 cases of healthy volunteers were selected as the healthy group.The levels of ADA,LDH and the activity of TB-Ab were compared between the two groups.The sensitivity and specificity of 3 indexes for tuberculosis were calculated.Results The levels of LDH and ADA in the tuberculosis group were significantly higher than those in the control group(P<0.05).The positive rates of LDH,ADA and TB-Ab in the tuberculosis group were significantly higher than those in the healthy group(P<0.05).The positive rate of three indicators combined detection of the tuberculosis group(92.9%,65/70)was significantly higher than that of the healthy group(1.4%,1/70,P<0.05).The sensitivity and specificity of LDH,ADA and TB-Ab combined detection of tuberculosis were 92.9%and 98.6%,respectively,which were significantly higher than the sensitivity(78.6%,81.4%and 85.7%)and specificity(95.7%,94.3%and 97.1%)separately detected by each indicator,and the differences were statistically significant(P<0.05).Conclusion Combined detection of LDH,ADA and TB-Ab in bronchoalveolar lavage fluid can improve the accuracy of diagnosis,and can be used as important reference for the early diagnosis and differential diagnosis of pulmonary tuberculosis.