胸腔积液LPS、IL-35、RORα表达在结核性胸膜炎、恶性胸膜炎鉴别诊断中的价值

The value of pleural fluid LPS,IL-35,and RORαin the differential diagnosis of tuberculous and malignant Pleurisy

目的探讨胸腔积液脂多糖(LPS)、白细胞介素(IL)-35、维甲酸相关孤儿受体α(RORα)表达在结核性胸膜炎和恶性胸膜炎鉴别诊断中的价值。方法选择本院2018年1月至2020年12月收治的结核性胸膜炎患者75例(良性组)和恶性胸膜炎患者54例(恶性组),两组患者均于无菌条件下进行胸腔穿刺术,抽取胸腔积液进行腺苷脱氨酶(ADA)、LPS、IL-35、RORα、鳞癌抗原(SCC)、神经源特异性烯醇化酶(NSE)、白蛋白、乳酸脱氢酶(LDH)含量测定,并进行白细胞计数和单核细胞计数测定。比较良性组、恶性组年龄、性别、体质量指数、吸烟史、饮酒史、胸腔积液的实验室检查等临床资料,多因素logistic回归分析良性胸膜炎发生的影响因素。绘制受试者工作特征(ROC)曲线,评价胸水LPS、IL-35、RORα单独和联合检测对结核性胸膜炎和恶性胸膜炎鉴别诊断价值。结果良性组胸水ADA、LDH、LPS、IL-35、RORα含量及白细胞计数、单核细胞计数均显著高于恶性组,差异有统计学意义(P<0.05);多因素logistic回归分析显示胸水中LPS、IL-35、RORα是结核性胸膜炎的影响因素;胸水LPS、IL-35、RORα联合检测鉴别结核性胸膜炎和恶性胸膜炎价值均高于各指标单独应用(P<0.05),差异均有统计学意义。结论结核性胸膜炎胸腔积液中LPS、IL-35、RORα呈高表达,胸腔积液LPS、IL-35、RORα在结核性胸膜炎和恶性胸膜炎的鉴别诊断中具有较高的临床价值。

Objective To investigate the value of the expression of lipopolysaccharide(LPS),interleukin-35(IL-35),and retinoic acid-related orphan receptorsα(RORα)in pleural effusion in the differential diagnosis of tuberculous pleurisy and malignant pleurisy.Methods 75 patients with tuberculous pleurisy(benign group)and 54 patients with malignant pleurisy(malignant group)treated in our hospital from January 2018 to December2020 were selected.Both groups underwent thoracentesis under strict aseptic conditions,and the pleural effusion was extracted for adenosine deaminase(ADA),LPS,IL-35,RORα,Squamous cell carcinoma antigen(SCC),neuron-specific enolase(NSE),albumin and lactate dehydrogenase(LDH)determination,and white blood cell count and monocyte count were also measured.The age,sex,body mass index,smoking history,drinking history,laboratory examination of pleural effusion,and other clinical data between the two groups were compared,and the influencing factors of benign pleurisy were analyzed by multivariate logistic regression.The receiver operating characteristic(ROC)curve was drawn to evaluate the values of LPS,IL-35,and RORαin pleural effusion alone andcombination in the differential diagnosis of tuberculous pleurisy and malignant pleurisy.Results The pleural fluid ADA,LDH,LPS,IL-35,RORαcontent,white blood cell count,and monocyte count of the benign group were significantly higher than those of the malignant group,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that LPS,IL-35,and RORαin pleural effusion were the influencing factors of tuberculous pleurisy.The combined detection value of LPS,IL-35,and RORαin the differential diagnosis of tuberculous pleurisy and malignant pleurisy was higher than that of each index alone,and the differences were statistically significant(P<0.05).Conclusion LPS,IL-35,and RORαare highly expressed in the pleural effusion of tuberculous pleurisy LPS,IL-35,and RORαin pleural effusion have high clinical value in the differential diagnosis of tuberculous pleurisy and malignant pleurisy..