对基于CA125、ADA及IL-27的C-P-O结核性胸腔积液评分系统的探讨

Exploration of C-P-O Tuberculous Pleural Effusion Scoring System Based on CA125, ADA and IL-27

目的:从胸腔积液的性质、具体病理情况、内科胸腔镜的可操作性探讨CA125联合ADA、IL-27在结核性胸腔积液的诊断价值,并构建基于这三者的C-P-O结核性胸腔积液评分系统。方法:回顾性分析2017年3月-2018年11月南方医科大学顺德医院确诊为胸腔积液并已行内科胸腔镜检查患者的胸腔积液的CA125、ADA、IL-27水平及胸腔镜活检的病理类型。以结核性与非结核性胸腔积液、渗出性与非渗出性病理为主的结核性胸膜炎、凝血功能延长性异常与正常、合并与不合并胸肺粘连、合并与不合并双侧胸腔积液进行两两分组,比较各分组下CA125、ADA、IL-27三指标水平的差异并明确主要涉及指标。以结核性与非结核性胸腔积液两组间水平比较筛选出来的影响指标构建C评分,分析各评分下胸腔积液性质、病理类型、凝血功能延长性异常、胸肺粘连占比的差异。结果:IL-27、ADA及CA125在结核性与非结核性胸腔积液水平存在差异(U=41.00、49.50、68.00,P=0.001、0.003、0.033),ADA的水平在结核性胸膜炎中的渗出性与非渗出性病理类型之间、APTT延长性异常为主的凝血功能异常与正常的凝血功能之间存在差异(U=19.00、42.50,P=0.035、0.038),CA125在胸肺粘连发生与否的水平存在差异(U=63.00,P=0.02)。双侧胸腔积液与上述三指标无明显相关(P>0.05)。筛选出ADA及IL-27参与C评分,3~4分下结核性胸腔积液占比较0~1高(P<0.05);4分下以渗出型为主要病理类型的占比较3分高(P=0.030);3分下APTT延长性异常占比较4分高(P=0.005);3~4分区较0~1分区更容易出现胸肺粘连异常(P=0.025)。结论:C评分下3~4分偏向结核性胸腔积液,0~1分偏向非结核性胸腔积液;4分相对3分更偏向于渗出性病理类型为主的结核性胸膜炎;3分较4分更容易出现以APTT延长性异常为主的凝血异常;3~4分相对0~1分更容易出现胸肺粘连。

Objective: To explore the value of carbohydrate antigen 125(CA125), adenosine deaminase(ADA) and interleukin 27(IL-27) in diagnosing tuberculous pleural effusion(TPE) by means of analysing type of pleural effusion, nature of pathology as well as the practicability for the operation of medical thoracoscopy and to establish the C-P-O tuberculous pleural effusion scoring system based on above three indexes. Method: To make a retrospective anlysis of concentration of CA125, ADA and IL-27 as well as the nature of pathology received from medical thoracoscopy of patients in Shunde Hospital of Southern Medical University from March 2017 to November 2018. To divide patients into several couple groups depending on TPE or non-TPE, exudative or non-exudative pathology, prolonged coagulation dysfunction or normal, combined or incompatible with pleural and pulmonary adhesion and bilateral or non-bilateral pleural effusion. The concentration of difference of CA125, ADA and IL-27 in each group will be anlysed in order to identify the main related indicator. The C score was constructed by the main related indicator that originated from the comparison of concentration of above indexes between TPE and non-TPE groups. The differences of the type of pleural effusion, pathological types, prolonged coagulation dysfunction and the rate of pleural and pulmonary adhesions under each score were analyzed. Result: The concentration of IL-27, ADA and CA125 in TPE and non-TPE were different(U=41.00, 49.50, 68.00, P=0.001, 0.003, 0.033). There are differences in the concentration of ADA between exudative and non exudative pathological types in tuberculous pleurisy, and between APTT prolonged abnormal coagulation and normal coagulation(U=19.00, 42.50, P=0.035, 0.038). There was difference in the concentration of CA125 between combined or incompatible with pleural and pulmonary adhesion. There was no significant correlation between the above three indexes and bilateral pleural effusion(P>0.05). ADA and IL-27 were screened for constructing the C score. The percentage of TPE was higher in 3-4 score than 0-1 score(P<0.05). The percentage of exudative type was higher in group scored as 4 than that as 3(P=0.030). The percentage of prolonged abnormality of APTT was higher in group scored as 3 than that as 4(P=0.005). The percentage of pleural and pulmonary adhesion was higher in group scored as 3-4 than that as 0-1(P=0.025). Conclusion: Under the C score, 3-4 points inclined to TPE while 0-1 points inclined to non-TPE. 4 points were more inclined to tuberculous pleurisy with exudative pathological type than 3 points, 3 points were more prone to coagulation abnormality with prolonged APTT abnormality than 4 points, 3-4 points were more prone to pleural and pulmonary adhesion than 0-1 points.