年龄对结核性胸腔积液和恶性胸腔积液患者腺苷脱氨酶水平及其鉴别诊断效能的影响

Effects of age on adenosine deaminase levels in tuberculous pleural effusion and malignant pleural effusion patients and its differentially diagnostic efficiency

目的分析年龄对结核性胸腔积液(TPE)和恶性胸腔积液(MPE)患者腺苷脱氨酶(ADA)水平及其鉴别诊断效能的影响。方法纳入130例TPE患者和90例MPE患者。分析TPE、MPE患者胸腔积液ADA水平与年龄的关系,并比较不同年龄段TPE和MPE患者之间胸腔积液ADA水平。采用受试者工作特征(ROC)曲线分析在不同年龄段患者中胸腔积液ADA水平鉴别诊断TPE和MPE的效能。采用Logistic回归模型分析不同年龄段人群中胸腔积液ADA水平与胸腔积液性质的相关性。结果(1)在全部患者和TPE患者中,<50岁患者胸腔积液ADA水平高于≥50岁患者,年龄与胸腔积液ADA水平呈负相关(均P<0.05);而在MPE患者中不同年龄段患者的胸腔积液ADA水平差异并无统计学意义(P>0.05),年龄与胸腔积液ADA水平无明显相关性(P>0.05)。(2)无论是在<50岁患者还是≥50岁患者中,TPE患者的胸腔积液ADA水平均高于MPE患者(均P<0.05)。(3)在不同的年龄段中,胸腔积液ADA水平对于鉴别TPE和MPE均具有一定的效能,但与<50岁患者相比,胸腔积液ADA水平用于鉴别≥50岁患者胸腔积液性质时的临界值更低,曲线下面积更小(P<0.05),敏感性和特异性更差。(4)随着胸腔积液ADA水平升高,患者诊断为TPE的可能性增加(P<0.05),但胸腔积液ADA水平预测患者诊断为TPE的概率随年龄的增长而有所降低。结论TPE患者的胸腔积液ADA水平随着年龄增加而降低。在鉴别TPE和MPE时,随着胸腔积液ADA水平升高,患者诊断为TPE的可能性增加,但概率随年龄的增长而降低;对于年龄较大患者,诊断TPE时需使用更低的ADA临界值,但敏感性和特异性较差。

Objective To analyze the effects of age on the levels of adenosine deaminase(ADA)in tuberculous pleural effusion(TPE)and malignant pleural effusion(MPE)patients and its differentially diagnostic efficiency.Methods A total of 130 TPE patients and 90 MPE patients were enrolled.The relationship of the ADA level in pleural effusion with age was analyzed in patients with TPE and MPE,and the level of ADA in pleural effusion was compared between TPE and MPE patients in different age groups.The receiver operating characteristic(ROC)curve was used to analyze the efficiency of the pleural effusion ADA level in differentiating TPE from MPE among patients in different age groups.The Logistic regression model was employed to analyze the correlation between the level of ADA in pleural effusion and the nature of pleural effusion among populations in different age groups.Results(1)Among all patients and TPE patients,those younger than 50 years old yielded a higher level of ADA in pleural effusion than those not younger than 50 years old,and age negatively correlated with the level of ADA in pleural effusion(all P<0.05);whereas there were no statistically significant difference in the level of ADA in pleural effusion between MPE patients in different age groups(P>0.05),and there was no evident correlation between age and the level of ADA in pleural effusion(P>0.05).(2)Both in patients younger than 50 years old and patients not younger than 50 years old,TPE patients yielded a higher level of ADA in pleural effusion than MPE patients(all P<0.05).(3)In different age groups,the level of ADA in pleural effusion had definite efficiency for differentiating TPE from MPE;however,compared with patients younger than 50 years old,the level of ADA in pleural effusion yielded a lower cutoff value,a smaller area under the curve(P<0.05),and poorer sensitivity and specificity in identifying the nature of pleural effusion in patients not younger than 50 years old.(4)Patients′possibility of being diagnosed with TPE was elevated with the increasing level of ADA in pleural effusion(P<0.05),but patients′possibility of being diagnosed with TPE predicted by the level of ADA in pleural effusion was declined with the increasing age.Conclusion TPE patients see a decline in the level of ADA in pleural effusion with the increasing age.When being differentiated TPE from MPE,patients′possibility of being diagnosed with TPE is elevated with the increasing level of ADA in pleural effusion,but the possibility is decreased with the increasing age;the detection of TPE in older patients needs a lower cutoff value of ADA but exhibits poorer sensitivity and specificity.