γ干扰素释放试验结合生化指标在诊断结核性胸腔积液中的作用

Role of pleural effusion gamma interferon release test combined with biochemical markers in the diagnosis of tuberculous pleural effusion

目的探讨胸腔积液γ-干扰素释放试验(Interferon-γrelease assays,IGRAs)结合其他生化指标在结核性胸腔积液诊断中的作用,为结核性胸腔积液诊断提供新的方法。方法收集2010年1月-2016年12月份在深圳市第三人民医院住院的201例患者的胸腔积液,并分为结核性胸腔积液(Tuberculous pleural effusion,TPE)和恶性胸腔积液(Malignant pleural effusion,MPE)。检测胸腔积液腺苷脱氨酶(Adenosine deaminase,ADA)、癌胚抗原(Carcinoembryonic antigen,CEA)水平,并分离出胸腔积液单个核细胞(Pleural fluid mononuclear cells, PFMCs)进行IGRAs。采用Graphpad软件作图并绘制ROC曲线分析,采用SPSS 17.0软件进行数据的统计分析。结果结核分枝杆菌特异性重组蛋白抗原ESAT-6刺激PFMCs后,TPE和MPE患者特异性斑点形成细胞数(Spots-forming cells,SFCs)分别为276.1±12.08和65.26±11.65,两组差异有统计学意义(P<0.01),ROC分析显示其相应的曲线下面积(Area under curve,AUC)为0.89;ADA和CEA可有效地用于区分TPE和MPE患者,ADA在TPE患者中的含量较高(65.56±1.99) U/L,其AUC为0.95,CEA在MPE患者中的含量较高(94.6±8.86)U/L,其AUC为0.97;当IGRA未联合ADA或CEA时,其灵敏度和特异度分别为96.38%和29.31%或99.22%和30.19%,当IGRA联合ADA或CEA时可以提高TPE诊断效能,其灵敏度和特异度分别为81.88%和98.28%或86.72%和100.00%。结论胸腔积液γ-干扰素释放试验联合ADA或CEA可以提高TPE患者诊断效能。

Objective To investigate the role of gamma IFN release test combined with its biochemical markers in tuberculous pleural effusion, and to provide a new diagnostic method for tuberculous pleural effusion. Methods A total of hospitalized 201 patients were enrolled in this investigation at Shenzhen Third People′s Hospital from January 2010 to December 2016. All the patients with pleural effusion were categorised into 2 groups: tuberculous pleural effusion(TPE) category and malignant pleural effusion(MPE)category. Adenosine deaminase(ADA), carcinoembryonic antigen(CEA) levels were detected, and isolation of pleural effusion mononuclear cells(PFMCs) for interferon-γ release test(IGRAs). Graphical analysis and ROC curve analysis are performed using Graphpad software, and statistical analysis of data is performed using SPSS 17.0 software.Results Our results show that the specific spots-forming sells(SFCs)is 276.1±12.08 in TPE patients, and 65.26±11.65 in MPE patients after stimulated by M. tuberculosis-specific recombinant protein antigen ESAT-6, which have a significant difference between the above two groups( P<0.01). ROC analysis show that the area under curve is 0.89. ADA and CEA are effectively used to distinguish patients between TPE and MPE, and ADA has higher content in TPE patients(65.56±1.99) U/L and the area under curve can reach 0.95;CEA has higher content in MPE patients(94.6 ± 8.86) U/L, whose AUC is0.97;when γ-interferon release test(IGRA) un-combined with ADA or CEA, the sensitivity and specificity are 96.38% and29.31% or 99.22% and 31.19%, respectively. However, when IGRA combined with ADA or CEA, the diagnostic efficacy of TPE is improved, and its sensitivity and specificity are 81.88% and 98.28% or 86.72% and 100.00%, respectively. Conclusion The combination of pleural effusion IGRA and ADA or CEA can effectively distinguish patients with TPE and MPE.