RANTES、ADA及PEMC联合检测对结核性胸腔积液的诊断价值

Diagnostic value of RANTES,ADA,and PEMC in tuberculous pleural effusion

目的探讨胸腔积液中腺苷脱氨酶(ADA)、调节活化正常T细胞表达和分泌细胞因子(RANTES)及胸腔积液单核细胞(PEMC)联合检测对结核性胸腔积液(TPE)的诊断价值。方法选取45例TPE患者(结核组)及41例恶性肿瘤胸腔积液患者(恶性组)作为研究对象,收集病历系统中2组患者胸腔积液ADA及PEMC检测结果;抽取2组患者新鲜胸腔积液5 mL,采用酶联免疫吸附法(ELISA)测定胸腔积液中RANTES浓度;采用受试者工作曲线(ROC)下面积,评价ADA、RANTES、PEMC单项检测及联合检测对TPE的诊断价值。结果结核组患者胸腔积液中ADA、RANTES及PEMC水平均明显高于恶性组,差异均有高度统计学意义(P<0.01);单项指标检测中,RANTES的灵敏度最高、ADA次之、PEMC最低;就特异度而言,仅有ADA>90%;两两联合中,除了ADA+RANTES的灵敏度<90%,其余指标两两联合的灵敏度及特异度均>90%,相较3项指标单独检测诊断价值高;3项指标联合应用诊断TPE的综合诊断效能最佳。结论ADA、RANTES及PEMC 3项指标联合检测诊断TPE具有更高的临床价值。

Objective To investigate the diagnostic values of the combined detection of adenosine deaminase(ADA),regulated on activation,normal T cell expressed and secreted(RANTES),and pleural effusion mononuclear cells(PEMC)in tuberculous pleural effusion(TPE).Methods Forty-five patients with TPE(tuberculosis group)and 41 patients with malignant pleural effusion(malignant group)were selected.Their ADA and PEMC test results of pleural effusion in the medical record system were collected.Fresh pleural effusion(5 mL/patient)was collected for determining RANTES using enzyme-linked immunosorbent assay(ELISA).The area under the receiver operating curve(ROC)was used to evaluate the diagnostic value of ADA,RANTES and PeMc in TPE.Results The levels of ADA,RANTES,and PEMC in tuberculosis group were significantly higher than those in the malignant group(P<0.01).RANTES had the highest sensitivity,followed by ADA,and PEMC was the lowest.As far as the specificity is concerned,only the specificity of ADA was greater than 90%.In the pairwise combinations,except for the sensitivity of ADA+RANTES pair which is lower than 90%,the sensitivity and specificity were higher than 90%in other pairwise combinations,and higher than those of any individual indicator(ADA or PEMC or RANTES).The diagnostic values of these pairwise combinations were higher than those of any individual indicator alone.The combination of these three indicators had the best diagnosis for TPE.Conclusion The combined detection of ADA,RANTES,and PEMC in diagnosing TPE has high clinical value.