结核性和肺腺癌性胸腔积液中肺表面活性物质相关蛋白A、D的检测分析

目的探讨胸水中肺表面活性物质相关蛋白－A、D联合对原发性肺腺癌性与结核性胸腔积液的鉴别诊断价值。方法收集36例原发性肺腺癌性和28例结核性胸腔积液患者的胸水，采用 western blotting检测胸水中肺表面活性物质相关蛋白-A、D。结果原发性肺腺癌和结核性胸膜炎患者胸水中SP A光密度值分别为265.1±141.16和180.0±64.1；原发性肺腺癌和结核性胸膜炎患者胸水中SP-D光密度值分别为299.9±140.6和206.8±86.8。36例原发性肺腺癌患者中有23例胸水中SP-A＞250，有16例SP-D＞250，而SP-A＞250和（或）SP-D＞250有29例。28例结核性胸膜炎患者胸水中SP-A、SP-D均未超过250。结论肺表面活性物质相关蛋白A对结核性胸膜炎与原发性肺腺癌所致胸腔积液鉴别诊断有临床价值,联合肺表面活性物质相关蛋白D对两者的鉴别诊断更有意义。

Detection of lung surfactant protein-A and-D in pleural effusions due to lung adenocarcinoma and tubercular pleurisy

To study the value of combined determinations of surfactant -associated protein-D(SP-D) and -A (SP-A) in the pleural fluid in distinguishing lung adenocarcinoma and tubercular pleurisy. Methods SP-A and SP-D were determined in the pleural effusions from 36 patients with lung adenocarcinoma and 28 with tubercular pleurisy by western blotting. Results SP-A concentrations in pleural effusions due to lung adenocarcinoma and tubercular pleurisy were 265.1±141.16 and 180.0±64.1 respectively, and SP-D concentrations were 299.9±140.6 and 206.8±86.8, respectively. SP-A＞250 was found in 23 of 36 lung adenocarcinomas，SP-D＞250 in 16 of 36 lung adenocarcinomas， while increased values of SP-A and/or SP-D were found in pleural effusions from 29 of 36 lung adenocarcinomas. SP-A and -D values did not exceed 250 in any of 28 patients with tubercular pleurisy. Conclusions SP-A is a useful immunohistochemical marker for lung adenocarcinoma, and SP-A in pleural effusion is valuable in diagnosis of primary lung adenocarcinoma and tubercular pleurisy, however, a combination of SP-D and -A assays in pleural effusions will be better for discriminating lung adenocarcinoma from tubercular pleurisy.