胸腔积液中ADA、LDH诊断结核性和细菌性胸腔积液的临床价值

The clinical value of ADA and LDH in the Diagnosis of tuberculous and bacterial Hydrops in pleural Fluid

目的探讨胸腔积液中腺苷脱氨酶(ADA)和乳酸脱氢酶(LDH)诊断结核性和细菌性腔积液的临床价值。方法选取2015年6月—2019年6月在丹阳市人民医院接受治疗的90例胸腔积液患者为研究对象,根据最终出院诊断结果分为结核性胸腔积液组(n=31)、细菌性胸腔积液组(n=38)和肿瘤性胸腔积液组(n=21)。比较三组胸腔积液ADA、LDH水平,采用ROC曲线评估ADA、LDH诊断结核性、细菌性胸腔积液的效能。结果结核性胸腔积液组ADA水平高于细菌性胸腔积液组、肿瘤性胸腔积液组,差异显著(P<0.05);细菌性胸腔积液组LDH水平高于结核性胸腔积液组、肿瘤性胸腔积液组,差异显著(P<0.05)。ADA诊断结核性胸腔积液曲线下面积(AUC)为0.753,灵敏度、特异度分别为87.2%和62.9%;诊断细菌性胸腔积液AUC为0.511,灵敏度、特异度分别为29.3%和73.2%。LDH诊断结核性胸腔积液AUC为0.523,灵敏度、特异度分别为36.9%和67.8%;诊断细菌性胸腔积液AUC为0.801,灵敏度、特异度分别为89.1%和56.7%。结论不同类型的胸腔积液患者的胸腔积液ADA、LDH水平存在差异,ADA诊断结核性胸腔积液的效能优于LDH,LDH诊断细菌性胸腔积液的效能优于ADL。

Objective To explore the clinical value of pleural adenosine deaminase and lactate dehydrogenase in diagnosis of tuberculous and bacterial effusion in patients with pleural effusion.Methods 90 patients with pleural effusion who were treated in Danyang People's hospital from June 2015 to June 2019 were selected as subjects,the patients were divided into tuberculous pleural effusion group(n=31),bacterial pleural effusion group(n=38)and tumor pleural effusion group(n=21).The levels of ADA and LDH in pleural fluid in three groups were compared.The diagnostic efficacy of ADA and LDH in tuberculous and bacterial pleural effusion was evaluated by ROC curve.Results The level of ADA in tuberculous pleural effusion group was higher than that in bacterial pleural effusion group and tumor pleural effusion group(P<0.05),and the level of LDH in bacterial pleural effusion group was higher than that in tuberculous pleural effusion group and tumor pleural effusion group,the difference was significant(P<0.05).The area under the curve(AUC)of ADA was 0.753,and the sensitivity and specificity were 87.2%and 62.9%,respectively.The AUC of bacterial pleural effusion was 0.511,the sensitivity and specificity were 29.3%and 73.2%,respectively.The diagnosis of tuberculous pleural effusion AUC by LDH was 0.523,the sensitivity and specificity were 36.9%and 67.8%,respectively;Diagnosis of bacterial pleural effusion AUC was 0.801,the sensitivity and specificity were 89.1%and 56.7%.Conclusion The levels of ADA and LDH in different types of pleural effusion are different.ADA is better than LDH in diagnosing tuberculous pleural effusion,and LDH is better than ADL in diagnosing bacterial pleural effusion.