胸腔积液乳酸脱氢酶/腺苷脱氨酶在结核性胸腔积液诊断中的应用价值

Value of lactate dehydrogenase/adenosine deaminase in the diagnosis of tu berculous pleural effusion

目的:探讨胸腔积液乳酸脱氢酶(LDH)/腺苷脱氨酶(ADA)在结核性胸腔积液诊断中的应用价值。方法:回顾性分析揭阳市人民医院于2017年1月至2021年8月收治的206例胸腔积液患者的临床资料,将其中103例结核性胸腔积液患者作为探究组,将其中103例非结核性胸腔积液患者作为参照组。两组患者均完善临床生化、病原学检测、胸腔积液常规、ADA、LDH等检查,对比其一般资料的差异。采用受试者工作曲线(ROC)分析胸腔积液LDH/ADA对结核性胸腔积液的诊断价值。结果:探究组的年龄、血LDH水平、胸腔积液LDH/ADA均低于参照组,P<0.05。探究组血蛋白、胸腔积液蛋白、胸腔积液ADA的水平均高于参照组,P<0.05。进行多因素logstic回归分析的结果显示,血LDH和ADA、胸腔积液ADA和胸腔积液LDH/ADA的水平均是影响结核性胸腔积液发生的独立危险因素(P<0.05)。采用ROC曲线分析胸腔积液LDH/ADA诊断结核性胸腔积液效果的结果显示,胸腔积液LDH/ADA诊断结核性胸腔积液的最佳临界值为20,约登指数为0.670,ROC曲线下面积为0.892(95%CI:0.848~0.936),敏感度为78.6%,特异度为88.3%,诊断效果良好。结论:胸腔积液LDH/ADA对结核性胸腔积液的诊断价值较高。

Objective:To investigate the value of lactate dehydrogenase(LDH)/adenosine deaminase(ADA)in the diagnosis of tuberculous pleural effusion.Methods:The clinical data of 206 patients with pleural effusion admitted to Jieyang People’s Hospital from January 2017 to August 2021 were retrospectively analyzed,including 103 patients with tuberculous pleural effusion as the investigation group,and 103 patients with non-tuberculous pleural effusion as the reference group.Clinical biochemical,etiological detection,pleural effusion routine,ADA,LDH a nd other examinations were completed in both groups,and the differences in general data were compared.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of LDH/ADA in tuberculous pleural effusion.Results:The age,blood LDH level,and pleural effusion LDH/ADA of the study group were lower than those of the reference group(P<0.05).The levels of serum protein,pleural effusion protein and pleural effusion ADA in the investigation group were higher than those in the reference group(P<0.05).The results of LogSTIC regression analysis showed that the levels of LDH and ADA in blood,ADA in pleural effusion and LDH/ADA in pleural ef fusion were independent risk factors for the occurrence of tube rculous pleural effusion(P<0.05).ROC curve was used to analyze the effect of LDH/ADA in the diagnosis of tuberculous pleural effusion.The results showed that the optimal cut-off value of LDH/ADA in the diagnosis of tuberculous pleural effusion was 20,the Youden index was 0.670,and the area under the ROC curve was 0.892(95%CI:The sensitivity was 78.6%,the specificity was 88.3%,and the diagnostic effect was good.Conclusion:LDH/ADA has high diagnostic value for tuberculous pleural effusion.