结核性胸腔积液患者IL-31和IL-33水平及其诊断价值

IL-31 and IL-33 levels in tuberculous pleural effusion and their diagnostic value

目的 通过检测白细胞介素-31(IL-31)、IL-33在渗出性胸腔积液中的表达水平,探讨二者鉴别诊断价值,并联合胸水腺苷脱氨酶(ADA)进行分析.方法 选择2021年3-12月南昌大学第二附属医院收治的胸腔积液患者63例为研究对象,其中结核性胸腔积液(TPE)患者30例,恶性胸腔积液(MPE)患者21例,肺炎旁胸腔积液(PPE)患者12例;比较各组胸腔积液中IL-31、IL-33及其诊断效能,并对IL-31、IL-33及ADA进行相关性分析.结果 IL-31、IL-33及ADA在TPE组表达水平最高,且在TPE与MPE组间表达水平差异有统计学意义(P<0.05);IL-31、IL-33及胸腔积液ADA诊断TPE受试者工作特征(ROC)曲线对应的曲线下面积(AUC)分别为0.738,0.756,0.829,约登指数分别为 0.581,0.547,0.633;IL-31+ADA、IL-33+ADA、IL-31+IL-33+ADA 对应的AUC分别为0.837、0.857、0.873,约登指数分别为0.633,0.619,0.700;胸腔积液ADA与IL-31、IL-33均呈中等程度正相关(P<0.05),IL-31与IL-33呈正相关(r=0.852,P<0.001).结论 TPE中细胞因子IL-31、IL-33高于MPE,且对TPE的诊断具有良好的灵敏度及特异度;IL-31、IL-33及胸水ADA联合检测对TPE的诊断效能优于单项检测;IL-31、IL-33与胸水ADA在TPE、MPE中呈中等强度正相关,提示IL-31、IL-33对TPE具有重要的诊断价值.

OBJECTIVE To investigate the differential diagnostic value of IL-31 and IL-33 by detecting their expression levels in exudative pleural effusion,and to analyze their correlation with pleural effusion ADA and their combined diagnostic value.METHODS A total of 63 patients with pleural effusion admitted to the Second Affiliated Hospital of Nanchang University from Mar.2021 to Dec.2021 were selected as the study subjects,including 30 patients with TPE,21 patients with MPE,and 12 patients with PPE.The expression levels of IL-31 and IL-33 in pleural effusion and their diagnostic efficacy were compared among the groups,and the correlation analysis of IL-31,IL-33 and ADA was performed.RESULTS The expression levels of IL-31,IL-33 and ADA were the highest in TPE group,with statistical differences between TPE and MPEgroups(P<0.05).The receiver operator characteristic(ROC)curve analysis showed that the area under the curve(AUC)of IL-31,IL-33 and pleural fluid ADA for the diagnosis of TPEwas 0.738,0.756 and 0.829,respectively,and theYouden indexwere0.581,0.547 and 0.633,respectively.TheAUC corresponding to IL-31+ADA,IL-33+ADAand IL-31+IL-33+ADAwere 0.837,0.857and0.873,respectively,and theYouden indexwere0.633,0.619and0.700,respectively.ADAin pleural fluid was moderately positively correlated with IL-31 and IL-33(P<0.05),and IL-31 was positively correlated with IL-33(r=0.852,P<0.001).CONCLUSION The levels of cytokines IL-31 and IL-33 in TPE were significantly higher than those in MPE,which had good sensitivity and specificity for the diagnosis of TPE.The combined detection of IL-31,IL-33 and pleural effusion ADA was superior to the single detection for the diagnosis of TPE.Il-31 and IL-33 were positively correlated with pleural ADA in TPE and MPE,suggesting that IL-31 and IL-33 were of significant diagnostic value in TPE.