胸苷激酶1在胸腔积液鉴别诊断中的作用研究

The role of thymidine kinase1 play in distinguishing pleural effusions

目的探讨胸苷激酶1活性检测在胸腔积液鉴别诊断中的敏感度及特异度。方法回顾性分析诊断明确的肺炎旁胸腔积液、结核性胸腔积液、癌性胸腔积液患者的临床资料,收集并检测三组患者胸腔积液标本中胸苷激酶1活性并进行比较。结果三组胸腔积液胸苷激酶1含量分别为:肺炎旁胸腔积液组:(1.18±0.73)pmol/L、结核组活性(1.31±0.64)pmol/L、癌性组(2.07±1.47)pmol/L。统计分析显示癌性组胸苷激酶1含量高于肺炎旁胸腔积液组及结核组,差异有统计学意义,而肺炎旁组与结核组胸苷激酶1含量无统计学差异。在诊断价值分析方面,当胸苷激酶1≥1.28 pmol/L时支持癌性胸腔积液诊断,但是当胸苷激酶1<1.28 pmol/L时,无法鉴别肺炎旁和结核性胸腔积液。因此,胸苷激酶1对于癌性胸腔积液的诊断价值较好,对肺炎旁胸腔积液和结核性胸腔积液鉴别诊断效能差。临床可考虑与其他指标,如降钙素原、腺苷脱氨酶等指标联合诊断。结论胸腔积液胸苷激酶1含量在癌性胸腔积液与非癌性胸腔积液的鉴别诊断中有较好诊断价值。

Objective To investigate the of thymidine kinase 1in differential diagnosis of pleural effusion. Methods A retrospective analysis of thymidine kinase1 activity in the parapneumonic pleural effusion and tuberculous pleural effusion and malignant pleural effusion were conducted. Results The thymidine kinase 1 of this three groups are respectively:parapneumonic group (1.18±0.73pmol/L),tuberculosis group (1.31±0.64pmol/L),and cancer group (2.07±1.47pmol/L). It was shown that the activity of thymidine kinase 1 in cancer group was higher than that of inflammation group and tuberculosis group,the difference was statistical significance,but there was no significant difference between parapneumonic group and tuberculosis group. It supported the diagnosis of malignant pleural effusion when thymidine kinase 1 was greater than or equal to 1.28pmol/L,but when the thymidine kinase 1 was less than 1.28pmol/L,it was impossible to distinguish parapneumonic pleural effusion and tuberculous pleural effusion. Therefore,the diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion is well,but the diagnosis efficiency of thymidine kinase 1 in parapneumonic pleural effusion and tuberculous pleural effusion is not well. Conclusion The diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion and non-malignant pleural effusion is well.