胸腔积液IGRA、ADA、CEA值联合检测在结核性胸膜炎患者诊断鉴别中的应用

Application of Combined Detection with Pleural Effusion IGRA, ADA and CEA in the Differential Diagnosis of Patients with Tuberculous Pleurisy

目的:探究胸腔积液γ干扰素释放试验(IGRA)、腺苷脱氨酶(ADA)、癌胚抗原(CEA)值联合检测在结核性胸膜炎(TPE)患者诊断鉴别中的应用。方法:回顾性分析2016年1月—2020年1月因胸腔积液来我院就诊的患者116例,其中诊断为结核性胸膜炎患者64例作为结核组,恶性肿瘤患者52例作为恶性组,比较两组胸腔积液中的IGRA酶联免疫斑点(Elispot)法刺激的IFN-γ-Elispot数值、ADA及CEA水平,并探究联合检测诊断价值。结果:结核组中胸腔积液中用ESAT6和CFP10刺激的IFN-γ-Elispot数值及ADA均明显高于恶性组,CEA均低于恶性组(P<0.05);ESAT6、CFP10与ADA均呈正相关(P<0.05),ESAT6、CFP10与CEA均呈负相关(P<0.05);在诊断TPE时,CEA的AUC最高为0.942,优于IGRA、ADA(P<0.05)。三项指标联合鉴定TPE的灵敏度、特异度、准确率均较单一检测IGRA、ADA、CEA高(P<0.05)。结论:IGRA、ADA、CEA在鉴别TPE均有其优缺点,应将三者联合使用,来提高鉴别的准确性。

Objective:To explore the application of combined detection with interferon-gamma interferon release assay(IGRA),adenosine deaminase(ADA)and carcinoma-embryonic antigen(CEA)values in pleural effusion in the differential diagnosis of patients with tuberculous pleurisy(TPE).Methods:A retrospective analysis was performed on the 116 patients who were treated in the hospital due to pleural effusion from January 2016 to January 2020.Among them,there were 64 cases with CEA(tuberculosis group)and 52 cases with malignant tumor(malignant group).IFN-γ-Elispot values,levels of ADA and CEA in pleural effusion which were stimulated by enzyme-linked immunospot detection technology(Elispot)in IGRA were compared between the two groups.And the diagnostic value of combined detection was explored.Results:IFN-γ-Elispot values which were stimulated by early secretory antigenic target 6(ESAT6)and culture filtrate protein 10(CFP10),and ADA in pleural effusion in tuberculosis group were significantly higher than those in malignant group,while CEA was lower than that in malignant group(P<0.05).ESAT6 and CFP10 were positively correlated to ADA(P<0.05),while negatively correlated to CEA(P<0.05).The highest AUC of CEA for diagnosis of TPE was 0.942,which was better than that of IGRA and ADA(P<0.05).The sensitivity,specificity and accuracy of the three indexes for identifying TPE were higher than those of IGRA,ADA and CEA alone(P<0.05).Conclusion:IGRA,ADA and CEA are of their advantages and disadvantages in identifying TPE.The three should be applied jointly to improve identification accuracy.