高荧光细胞联合生化免疫指标对胸腔积液的诊断价值研究

Study on the diagnostic value of hyper-fluorescent cells combined with biochemical and immunological markers in pleural effusion

目的 探讨高荧光细胞(high-fluorescent cell, HFC)联合生化免疫指标在鉴别胸腔积液性质中的应用价值。方法 选取2018年7月至2020年4月清华大学附属北京清华长庚医院收治的住院患者122例,收集胸腔积液样本分为恶性积液组(49例)、类肺炎性积液组(53例)和结核性积液组(20例)。检测胸腔积液中高荧光强度细胞绝对值(HFBF#)、乳酸脱氢酶(lactate dehydrogenase, LDH)、腺苷脱氨酶(adenosine deaminase, ADA)、总蛋白(total protein, TP)、CEA、降钙素原(procalcitonin, PCT)和CRP,比较3组胸腔积液中HF-BF#和生化免疫指标的差异,采用二元logistic回归分析恶性积液的危险因素,采用ROC曲线建立联合诊断模型。结果 鉴别恶性积液和类肺炎性积液的最佳指标为HF-BF#和CEA,最佳诊断界值分别为61.0 cells/μl和14.17 ng/ml,二者联合鉴别两种积液的ROC曲线的AUC为0.899,灵敏度为77.6%,特异性为92.5%,约登指数为0.70;鉴别恶性积液和结核性积液的最佳指标为HF-BF#、CEA和ADA,最佳诊断界值分别为18.50 cells/μl、2.35 ng/ml和27.30 U/L,三者联合鉴别两种积液的ROC曲线的AUC为0.981,灵敏度为100.0%,特异性为93.9%,约登指数为0.94。结论 HFC与生化免疫指标的联合应用可以提高单项指标鉴别良恶性胸腔积液的诊断效能。

Objective To explore the diagnostic value of high-fluorescent cells combined with biochemical and immunological markers for benign and malignant pleural effusion. Methods A total of 122 inpatients admitted to Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from July 2018 to April 2020 were selected. The pleural effusion samples of these patients were collected and divided into malignant effusion group(n=49), pneumonia-like effusion group(n=53) and tuberculous effusion group(n=20). The absolute value of high fluorescence cells(HF-BF#), lactate dehydrogenase(LDH), adenosine deaminase(ADA), total protein(TP), CEA, procalcitonin(PCT) and CRP in pleural effusion were detected, and the differences of HF-BF# and biochemical and immune markers in pleural effusion were compared among the three groups. Binary logistic regression was used to analyze the risk factors of malignant effusion, and the ROC curve was used to establish a combined diagnostic model. Results The best indicators for distinguishing malignant effusion and pneumonic-like effusion were HF-BF# and CEA, and the optimal cut-off values were 61.0 cells/μl and 14.17 ng/ml,respectively. The area of the ROC curve for the combined identification of the two effusions was 0.899, with a sensitivity of77.6%, and a specificity of 92.5%, and youden index was 0.70. The best indicators for distinguishing malignant effusion from tuberculous effusion were HF-BF#, CEA and ADA, and the optimal cut-off values were 18.5 cells/μl, 2.35 ng/ml and 27.3 U/L,respectively. The area of the ROC curve for the combined identification of the two effusions was 0.981, with a sensitivity of100.0%, and a specificity of 93.9%, and youden index was 0.94. Conclusions The combined application of HFC and biological markers can improve the diagnostic value of single indicator in differentiating benign and malignant pleural effusion.