胸腔积液腺苷脱氨酶与干扰素-γ联合检测在结核性胸腔积液诊断中的临床意义

Clinical significance of combined detection of ADA and IFN-γfor pleural effusion in the diagnosis of tuberculous pleural effusion

目的:探讨胸腔积液腺苷脱氨酶(ADA)、干扰素-γ(IFN-γ)及二者联合检测在结核性胸腔积液诊断中的意义。方法:选取天津市北辰医院115例胸腔积液患者的临床资料。根据胸腔镜病理诊断结果分为结核性胸腔积液组(n=52)和非结核性胸腔积液组(n=63),分别采用酶显色法、酶联免疫吸附试验(ELISA)检测两组胸腔积液ADA水平和IFN-γ水平。使用多因素Logistic回归分析结核性胸腔积液的可能影响因素。绘制受试者工作特征曲线(ROC)分析不同指标诊断的敏感性及特异性。结果:病例组胸腔积液淋巴细胞计数(P=0.044)、ADA(P<0.001)、IFN-γ(P=0.009)高于对照组。Logistic回归分析显示胸水ADA水平(OR=2.148,P<0.001)、IFN-γ水平(OR=1.976,P<0.001)是结核性胸腔积液的独立危险因素。ADA检测的ROC曲线下面积最大为0.853(95%CI为0.785~0.922),最佳临界值为41.005 U/L,敏感性为0.725,特异性为0.889;IFN-γ检测的ROC曲线下面积最大为0.869(95%CI为0.805~0.932),最佳临界值为109.969 ng/L,敏感性为0.647,特异性为0.905。两者联合检测的ROC曲线下面积最大为0.980(95%CI为0.961~0.999)。结论:胸腔积液腺苷脱氨酶、干扰素-γ检测对结核性胸膜炎的诊断具有一定的临床意义,二者联合检测可进一步提高对结核性胸膜炎诊断的敏感性和特异性。

Objective To explore the significance of ADA,IFN-γand the combination of the two in the diagnosis of tuberculous pleural effusion.Method The clinical data of 115 patients with pleural effusion were collected.According to the pathological diagnosis results,they were divided into tuberculous pleural effusion group(n=52)and non-tuberculous pleural effusion group(n=63),and the ADA level and IFN-γlevel of pleural effusion were detected by colorimetric method and ELISA method,respectively.Multivariate logistic regression was used to analyze possible influencing factors of tuberculous pleural effusion.Plot ROC curves to analyze the sensitivity and specificity of diagnosis of different indicators.Results The lymphocyte counts of pleural effusions(P=0.044),ADA(P<0.001),and IFN-γ(P=0.009)in the case group were higher than those in the control group.Logistic regression analysis showed that pleural ADA levels(OR=2.148,P<0.001)and IFN-γlevels(OR=1.976,P<0.001)were independent risk factors for tuberculous pleural effusions.The area under the ROC curve detected by ADA was 0.853(95%CI:0.785~0.922),the optimal critical value was 41.005 U/L,the sensitivity was 0.725,and the specificity was 0.889,and the area under the ROC curve detected by IFN-γwas 0.869(95%CI:0.805~0.932),the optimal critical value was 109.969 ng/L,the sensitivity was 0.647,and the specificity was 0.905.The maximum area under the ROC curve detected by the two was 0.980(95%CI:0.961~0.999).Conclusion Pleural effusion ADA and IFN-γdetection have certain clinical significance for the diagnosis of tuberculous pleurisy,and the combination of the two can further improve the sensitivity and specificity of the diagnosis of tuberculous pleurisy.