sFasL检测对结核性与恶性胸腔积液鉴别诊断价值的探讨

目的探讨sFasL对恶性胸腔积液与结核性胸腔积液鉴别诊断价值。方法应用ELISA法分别检测32例恶性胸腔积液和43例结核性胸腔积液中sFasL的含量，对结果进行统计学处理。结果结核性胸腔积液组sFasL（13．56±5．38ng／m1）显著高于恶性胸腔积液组（5．72±2．59ng／m1），二者具显著性差异（P〈0．001）。以10ng／ml为临界值，胸腔积液中sFasL〉10ng／ml诊断为结核性胸腔积液的敏感性为81．4％（35／43），特异性为81．3％（26／32），临床诊断符合率为81．4％（61／75）。结论sFasL对结核性、恶性胸腔积液的鉴别诊断有临床实用价值。     

降钙素原在鉴别结核性和恶性胸腔积液中的应用价值

目的探讨胸腔积液中降钙素原(PCT)对鉴别结核性胸膜炎和恶性胸腔积液的临床价值。方法分析63例经内科胸腔镜胸膜活检确诊的结核性胸腔积液(33例)和恶性胸腔积液(30例)患者的胸腔积液中PCT水平,确定结核性胸膜炎患者胸腔积液中PCT的诊断最佳临界值。结果结核性胸腔积液中PCT水平为(0.387+0.199)ng/ml,明显高于恶性胸腔积液组的(0.126+0.069)ng/ml,差异有统计学意义(P<0.05);应用受试者工作曲线(ROC曲线)确定胸腔积液中PCT诊断结核性胸膜炎的最佳临界值为0.341 ng/ml,敏感性为80.1%,特异度为84.5%。结论胸腔积液中的PCT水平可以作为鉴别结核性和恶性胸腔积液的参考指标。     

血管内皮细胞生长因子C与腺苷脱氨酶联合检测在胸腔积液鉴别诊断中的意义

目的 了解血管内皮细胞生长因子C(VEGF-C)及腺苷脱氨酶(ADA)在不同原因胸腔积液中的表达,并探讨通过比值构建联合诊断对胸腔积液鉴别诊断的作用.方法 选择143例临床确诊的胸腔积液患者(恶性胸腔积液40例,结核性胸膜炎45例,其他类型58例),采用双抗夹心ELISA法检测胸水VEGF-C,采用速率法检测胸水ADA,计算VEGF-C/ADA比值,比较不同类型胸腔积液患者中上述诊断指标的变化,并计算它们的敏感度、特异度和准确度.结果 恶性胸腔积液中VEGF-C浓度高于结核性胸腔积液及类肺炎性等其他类型胸腔积液,(286.32±102.65)ng/L vs(133.46±39.83)ng/L,(140.14±44.62)ng/L,P<0.05.结核性胸腔积液中ADA浓度高于恶性胸腔积液及其他类型胸腔积液,(78.6±36.3)IU/L vs(23.4±11.2)IU/L,(26.1±10.5)IU/L,P<0.05.VEGF-C/ADA≥8对恶性胸腔积液诊断的敏感度为87.5%,特异度为81.4%;VEGF-C/ADA≤3对结核性胸腔积液诊断的敏感度为84.4%,特异度为86.4%.结论 VEGF-C与ADA浓度比值对胸腔积液的鉴别诊断具有较好的临床价值.     

ADA、IFN-γ在鉴别诊断结核性和恶性胸腔积液中的价值

目的探讨ADA(腺苷脱氨酶)、IFN-γ(γ-干扰素)在鉴别诊断结核性和恶性胸腔积液中的价值。方法对40例结核性胸腔积液患者(结核组),40例恶性胸腔积液患者(肿瘤组),分别在治疗前抽取适量胸腔积液,进行ADA活性、IFN-γ浓度测定。结果结核性胸腔积液中ADA活性、IFN-γ浓度显著高于恶性胸腔积液,差异具有显著性(P<0.01)。根据ROC(受试者工作特征)曲线评价ADA、INF-γ在鉴别诊断结核性胸腔积液和恶性胸腔积液中的价值,ADA、IFN-γ临界值分别为29.85U/L,151.77ng/L,其诊断结核性胸腔积液的敏感性分别为82.5%,92.5%,特异性为92.5%,95%,准确性为93.7%,98.5%。结论ADA、IFN-γ可作为诊断结核性胸腔积液的可靠指标,且IFN-γ具有更高的诊断能效。     

腺苷脱氨酶诊断结核性胸膜炎价值的再评价

目的 探讨胸腔积液和血清中腺苷脱氨酶(ADA)对鉴别结核性胸膜炎及恶性胸腔积液的临床价值.方法 回顾性分析91例经内科胸腔镜胸膜活检病理确诊为结核性胸腔积液(结核组49例)和恶性胸腔积液(恶性组42例)患者的胸腔积液及血清中ADA活性,应用受试者工作曲线(ROC曲线)确定结核性胸膜炎患者胸腔积液ADA的最佳临界值.结果 结核组胸腔积液ADA活性和胸腔积液ADA与血清ADA比值分别为(46±26)U/L和4.1±4.0,明显高于恶性组的(16±8)U/L和1.7±1.2,差异均有统计学意义(t值分别为7.383和3.852,均P＜0.01),结核组和恶性组的血清ADA活性分别为(13±5)U/L和(12±6)U/L,差异无统计学意义(t=1.582,P＞0.05).应用ROC曲线确定胸腔积液ADA诊断结核性胸膜炎的最佳临界值为28.7 U/L,灵敏度为75.5%,特异度为95.2%.结论 胸腔积液ADA活性可以作为鉴别结核性和恶性胸腔积液的重要指标,对结核性胸膜炎有较高的临床诊断价值,而血清ADA活性对鉴别两者无临床意义.     

联合检测对结核性和恶性胸腔积液的鉴别诊断价值

目的探讨联合检测胸腔积液中腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)对结核性和恶性胸腔积液的诊断价值。方法以我院2012年1月至2012年12月112例住院的胸腔积液患者为研究对象,其中62例结核性胸腔积液患者,50例恶性胸腔积液患者,以酶比色法,免疫比浊法,速率法和电化学发光法检测上述患者胸腔积液中ADA、CRP、CEA和LDH浓度。结果结核性胸腔积液患者ADA和CRP的诊断敏感性显著高于恶性胸腔积液患者(P0.01),恶性胸腔积液患者CEA的诊断敏感性较结核性胸腔积液患者明显增高(P0.01)。以胸腔积液CEA7 ng/ml及LDH245 U/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为78.0%,80.6%;而以CEA7 ng/ml,LDH245 U/L及ADA40 U/L,CRP5 mg/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为94.0%,95.2%。以胸腔积液ADA40 U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为82.3%,86.0%;而以CEA7 ng/ml,LDH245 U/L及ADA4 0U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为96.8%,92.0%。结论联合检测胸腔积液中ADA、CRP、CEA、LDH的浓度可提高结核性和恶性胸腔积液鉴别诊断的敏感性和特异性。     

白细胞介素-18对结核性和恶性胸腔积液的诊断价值

目的探讨胸腔积液中白细胞介素-18(IL-18)在结核性和恶性胸腔积液中的诊断价值。方法选取我院住院的未经治疗胸腔积液患者52例,其中结核性胸腔积液组23例,恶性胸腔积液组29例。采用双抗体夹心酶联免疫吸附法(ELISA)检测结核性和恶性胸腔积液中IL-18浓度。结果两组患者在胸腔积液中IL-18浓度显著高于血清中IL-18浓度,(P0.05),结核性胸腔积液组和恶性胸腔积液组在胸腔积液IL-18浓度相对比,差异具有统计学意义(P0.05),但两组在血清IL-18浓度相对比,差异无统计学意义(P0.05);以胸腔积液中IL-18诊断临界值为503.58 pg/ml,ROC曲线下面积97.7%,敏感度89.2%,特异性92.6%,准确度90.4%。结论检测胸腔积液中IL-18浓度对结核性和恶性胸腔积液有着重要的临床诊断鉴别价值。     

白介素18和腺苷脱氢酶联合检测鉴别结核性和恶性胸腔积液的价值

目的 探讨白介素18(IL-18)和腺苷脱氢酶(ADA)联合检测鉴别结核性和恶性胸腔积液的价值.方法采用ELISA法、酶速率法检测19例结核性和25例恶性胸腔积液患者胸水中IL-18及ADA水平,并利用SPSS11.0软件进行ROC曲线分析得出它们在鉴别结核性和恶性胸腔积液中的最适临界值,并计算出相应的敏感度、特异度、准确度.结果结核性胸腔积液患者IL-18及ADA水平明显高于恶性胸腔积液(P＜0.01),以358 pg/ml、33 U/L为IL-18、ADA为鉴别诊断结核性和恶性胸腔积液的最适临界值,其敏感度、特异度及准确度均＞80%.结论 IL-18和ADA可作为诊断结核性和恶性胸腔积液的有效参考指标.     

腺苷脱氨酶和癌胚抗原检测对结核性与恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶(ADA)和癌胚抗原(CEA)检测对结核性与恶性胸腔积液的鉴别诊断价值。方法用氨试剂法和ELISA法对118例胸腔积液的ADA和CEA进行检测分析。结果结核组与恶性组ADA活性有显著差异(P0.01)。恶性组与结核组CEA活性有显著差异(P0.01)。结核组和恶性组中ADA的阳性率分别为94.3%和8.7%,差异有统计学意义(P0.01)。恶性组和结核组中CEA的阳性率分别为69.6%和6.9%,差异有统计学意义(P0.01)。ADA≥40 U/L诊断结核性胸腔积液的灵敏度为94.3%,特异度为90.3%。CEA≥10μg/L诊断恶性胸腔积液的灵敏度为69.6%,特异度为93.7%。以ADA≥40 U/L和CEA10μg/L为阳性界值诊断结核性胸腔积液的灵敏度为87.8%,特异度为95.3%。以CEA≥10μg/L和ADA40 U/L为阳性界值诊断恶性胸腔积液的灵敏度为63.5%,特异度为99.2%。结论胸腔积液ADA及CEA检测对结核性与恶性胸腔积液有鉴别诊断价值。     

应用ROC曲线研究肾上腺髓质素对结核性与恶性胸腔积液的鉴别诊断价值

目的以细胞角质蛋白19片段(CYFRA211)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)为对照,研究肾上腺髓质素(adrenomedullin AM)对恶性胸腔积液的鉴别诊断价值,并研究联合检测的临床意义,为结核性与恶性胸腔积液的鉴别诊断提供实验依据。方法应用放射免疫法(RIA)分别检测恶性及结核性胸腔积液组病人胸腔积液中AM、CYFRA211、NSE、CEA含量,比较4项指标诊断肺癌的敏感性、特异性及准确性。结果(1)恶性胸腔积液中AM的含量(115.05±31.06pg/ml)明显高于结核性胸腔积液(71.40±10.80 pg/ml),有显著性差别(P<0.01);(2)AM诊断恶性胸腔积液敏感性、准确性较NSE、CEA显著增高(P<0.05),与CYFRA211相比无显著性差异(P>0.05);(3)4项指标联合检测敏感性、准确性提高到90.4%和89.4%,均高于单项检测,有显著性差异(P<0.05)。结论(1)胸腔积液中AM的检测可作为结核性与恶性胸腔积液鉴别诊断的实验室指标;(2)AM与CYFRA211、NSE、CEA的联合检测可进一步提高诊断敏感性和准确性,对提高恶性胸腔积液的鉴别诊断有较大的意义;(3)研究提示AM参与恶性胸腔积液的发生发展,推测干扰AM与其特异性受体的结合及信号转导途径可为恶性胸腔积液的治疗开辟新的研究思路。     

胸液P-选择素检测对结核性与恶性胸腔积液鉴别意义的探讨

目的　检测结核性及恶性胸腔积液患者胸液P-选择素水平,探讨其对鉴别良恶性疾病的意义。方法 采用酶联免疫吸附法(ELISA法)检测48例结核性胸液及50例恶性胸液P-选择素水平。结果 恶性胸液P-选择素水平(18.76±8.45μg/L)明显高于结核性胸液P-选择素(7.43±5.32μg/L)(P<0.01)。结论 测定胸液P-选择素水平有助于结核性及恶性胸液的鉴别。     

P-选择素等多项指标检测在胸腔积液鉴别中的应用价值

目的分别检测结核性与恶性胸腔积液(以下简称胸液)中检测P-选择素、IL-1α、sFas、sFasL、AM(肾上腺髓质素)含量并与癌胚抗原(CEA)比较,探讨各检测方法及联合检测在结核性与恶性胸液鉴别诊断中的价值。方法在结核性与恶性胸液中,应用ELISA法检测P-选择素、IL-1α、sFas、sFasL的含量;用放射免疫法(RIA)分别检测AM与CEA含量,对所得数据进行统计学处理。结果(1)结核性胸液中P-选择素、IL-1α含量均明显低于恶性胸液组,分别为(t=8．71,P＜0．01),(t= 6．80,P＜0．01);(2)结核性胸液中sFas、sFasL含量均明显高于恶性胸液组,分别为(F=4．451,t= 6．422,P＜0．001);(F=5．760,t=6．866,P＜0．001);(3)结核性胸液中AM、CEA含量均明显低于恶性胸液组,分别为(t=7．49,P＜0．05);(t=6．37,P＜0．01)。结论P-选择素、IL-1α、sFas、sFasL与AM在对结核性与恶性胸液的鉴别诊断上,敏感性、特异性及临床诊断符合率均高于CEA,有较高的临床实用价值。ELISA法中以P-选择素为优,放免法以AM为优,联合检测可明显提高其临床诊断符合率。     

Vascular endothelial growth factor and proinflammatory cytokines in pleural effusions

To evaluate the predictive value of vascular endothelial growth factor (VEGF) in the differential diagnosis of pleuritis and its association with other proinflammatory cytokines in pleural effusion, we measured VEGF together with interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha) and soluble intercellular adhesion molecule-1 (sICAM-1) in pleural effusions. We investigated 127 patients with pleural effusion (congestive heart failure: 21; parapneumonic: 27; tuberculous: 41; malignant: 38). We examined standard parameters of pleural effusion and measured pleural effusion VEGF, IL-1beta, TNF-alpha and sICAM-1 using enzyme-linked immunosorbent assay. VEGF level was significantly higher in malignant effusion than in other groups. TNF-alpha level was significantly higher in tuberculous pleurisy than in other groups. In tuberculous pleurisy VEGF level showed significant positive correlations with mononuclear cell counts and all investigated cytokines. The sensitivity and specificity of VEGF in the diagnosis of malignancy was 100 and 84%, respectively (cutoff = 2000 pg/ml). The sensitivity and specificity of VEGF and TNF-alpha in the diagnosis of tuberculous pleurisy (VEGF titer <2000 pg/ml and TNF-alpha titer > 55 pg/ml) was 88.9 and 77.1%, respectively. We propose that measurement of VEGF together with TNF-alpha is helpful in differentiating between tuberculous pleurisy and malignant pleural effusion and that VEGF correlates with proinflammatory cytokines especially in tuberculous pleurisy. We also propose that measurement of pleural VEGF is helpful for the diagnosis of malignant pleural effusion.     

TB-Ab-IgG ADA和CEA对良恶性胸水鉴别诊断意义

目的　探讨胸水结核抗体 (TB-Ab-IgG)、腺苷脱氨酶 (ADA)、癌胚抗原 (CEA)联合检测对良恶性胸腔积液的鉴别价值。方法 采用DIGFA法、Giusti改良法和放射免疫法对 92例胸腔积液行胸水TB Ab IgG、ADA和CEA检测分析。 结果 TB Ab IgG在结核性、癌性和其它组胸腔积液中的阳性率分别是 81.8%、12 .8%和 1.1% ,特异性为 87.5 % ;ADA活性在结核性和癌性胸腔积液中分别为 (5 9.6± 2 8.8)U/L和 (2 4 .7± 11.5 )U/L(P <0 .0 1) ,CEA为 (8.5± 7.3)ng/mL和 (6 0 .2± 39.6 )ng/mL(P <0 .0 1) ,ADA在其它组胸腔积液中为 (44 .6± 2 6 .5 )U /L ,与结核性胸腔积液相比 (P >0 .0 5 )。结论 胸腔积液TB Ab IgG、ADA、CEA检测对良恶性胸腔积液有鉴别价值。     

Macrophage-derived chemokine in malignant and tuberculous pleural effusions

BACKGROUND AND OBJECTIVES: Macrophage-derived chemokine (MDC/CCL22) is recognized as a T-helper (Th) 2-type chemokine. Both malignant and tuberculous pleural effusions are typically lymphocytic pleural effusions. Tuberculous pleural effusions have a more polarized Th1 reaction than malignant effusions, which are predominantly Th2 in nature. The aim of this study was to compare the levels of MDC in malignant pleural effusions with those in tuberculous pleural effusions to help delineate the role of MDC in Th2 versus Th1 effusions. METHODS: Forty-three patients with pleural effusions (32 malignant, 11 tuberculous) were studied. The concentration of MDC in the pleural effusion was measured by ELISA. RESULTS: The median concentration of MDC was lower in malignant pleural effusions than in tuberculous pleural effusions (P < 0.005). CONCLUSIONS: MDC has been reported to both promote and suppress antitumour immunity. The low concentration of MDC in malignant effusions is likely to minimise its antitumour activity but the precise role of MDC in malignant and tuberculous effusions needs to be investigated further.     

Pleural SC5b-9 in differential diagnosis of tuberculous, malignant, and other effusions.

A monoclonal antibody against soluble phase-terminal complement complex (SC5b-9) was used to try to differentiate pleural effusions of tuberculous vs malignant and other origin. Effusions of tuberculous origin showed a significantly higher SC5b-9 level than did plasma, suggesting activation of complement in the pleural space. All 26 patients with tuberculous effusions showed SC5b-9 levels in pleural fluid exceeding 2.0 mg/L, while 20 with malignant effusions had levels less than 2.0 mg/L. However, rheumatoid, some parapneumonic, and treated malignant effusions showed SC5b-9 levels above 2.0 mg/L. Considering a value exceeding 2.0 mg/L, the specificity and sensitivity of the SC5b-9 estimation in tuberculosis were 0.74 and 1.0, respectively. The mean values for C4d and Bb fragments of complement were significantly (p < 0.05) higher in the tuberculous than in the malignant effusions. However, the values for Bb in 16 (62 percent) of the 26 patients with tuberculous or malignant effusions were in the same range. The activity of adenosine deaminase (ADA) was higher in the tuberculous than in the malignant effusions. While 18 of 26 patients with tuberculous effusions showed an ADA value exceeding 50 mU/ml, the estimated cutoff point (sensitivity = 0.69), 35 of the 36 nontuberculous effusions showed a true negative value (specificity = 0.97). A correlation between ADA and SC5b-9 values was observed in pleural effusions. These observations suggest that the estimation of SC5b-9 in pleural fluid presents a new approach to differentiating tuberculous vs malignant effusions.     

Immunocytochemistry and ELISA quantitation of mucin for diagnosis of malignant pleural effusions.

One hundred and thirty-five pleural effusions with definite etiology were analyzed by mucin-specific monoclonal antibody (17Q2)-derived enzyme-linked immunosorbent assay (ELISA). Twenty-four effusions were transudate, 45 were nonmalignant exudate, and 66 were malignant. Among the 66 malignant effusions, 52 were adenocarcinoma, and 14 were malignancies other than adenocarcinoma. Purified mucous glycoproteins from sputa of normal subjects were used as ELISA standard. Our results showed that the mean mucin concentration in malignant pleural effusions were significantly higher than that of benign exudates (8.41 +/- 13.48 ng/ml versus 1.09 +/- 0.82 ng/ml, p < 0.01). Mucin concentration in malignant pleural effusions caused by adenocarcinoma was also significantly higher than in non-adenocarcinoma effusions (9.96 +/- 14.81 ng/ml versus 2.66 +/- 1.74 ng/ml, p < 0.01). With the use of mean +/- 2 SD of mucin concentration in benign exudates as a cut-off value (2.73 ng/ml), the sensitivity of this assay for diagnosis of malignant effusions was 66.7%, specificity was 97.1%, and accuracy was 82.2%. High levels of mucin concentration were more specifically associated with adenocarcinoma. When the mucin concentration in pleural effusions was greater than 5 ng/ml, 93.1% (27/29) of patients were adenocarcinoma. If the mucin concentration was greater than 10 ng/ml, 100% (14/14) of patients were adenocarcinoma. Immunofluorescent staining by mucin-specific monoclonal antibody 17Q2 were also carried out in diastase-treated cell preparations obtained from 22 patients with malignant pleural effusions and 16 benign exudates. Nine of 14 adenocarcinomas (64.2%) were reactive with monoclonal antibody 17Q2, while none of the benign exudates, squamous cell carcinomas, and mesotheliomas were stained.(ABSTRACT TRUNCATED AT 250 WORDS)     

Usefulness of pleural complement activation products in differentiating tuberculosis and malignant effusions.

OBJECTIVE: To determine whether measurement of the complement activation products SC5b-9 and C3a-desArg in pleural fluid can reliably differentiate tuberculous from malignant pleural effusions. DESIGN: Twenty-four patients with tuberculous pleuritis, 29 with malignant pleural effusion, and 30 control subjects with transudates were enrolled in the study. SCSb-9 and C3a-desArg were measured in pleural fluid using commercial ELISA tests, and their performances were evaluated using receiver operating characteristic (ROC) analysis. RESULTS: Patients with tuberculous pleuritis had higher mean levels of pleural SC5b-9 (5052 microg/L) and C3a-desArg (7436 microg/L) than those with malignant effusions (1048 and 2835 microg/L, respectively), whereas only SC5b-9 concentrations in the latter were comparable with controls. The area under the ROC curve (AUC) was 0.84 for SC5b-9 and 0.81 for C3a-desArg. Pleural SC5b-9 showed an accuracy of 80.8%, compared with 78.8% for C3a-desArg, when cut-off points of 1500 and 4500 microg/L, respectively, were used. Using a stepwise logistic regression model, the combination of pleural SCSb-9 > or =1500 microg/L, age < or =35 years, and pleural monocyte percentage > or =90% provided the highest accuracy for tuberculous pleurisy (88.5%, AUC 0.95). CONCLUSION: This pilot study suggests that pleural SC5b-9 is clinically useful for differentiating tuberculous and malignant pleural effusions.     

Carcinoembryonic antigen levels in benign and malignant pleural effusions

One hundred ninety-one unselected fluid specimens submitted routinely for cytologic examination were assayed to determine whether the measurement of carcinoembryonic antigen (CEA) levels in pleural effusions is useful in detecting malignancy. The mean +/- SD CEA level of 103 benign effusions was 4.1 +/- 2.9 ng/ml. Only one benign effusion had a level greater than 12 ng/ml (18 ng/ml). Benign inflammatory effusions (pneumonia, empyema) had a higher mean CEA activity (6.2 +/- 3.4) than effusions caused by congestive heart failure (2.9 +/- 1.5) (p less than 0.001). Twenty-four (34%) of 70 malignant effusions had a CEA level greater than 12 ng/ml, and 28 (40%) were "positive" by cytologic study. Thirty-eight (54%) were detected by one or both methods. Ten malignant effusions were positive by CEA (greater than 12 ng/ml) alone. These data suggest that the determination of CEA activity levels, when used in conjunction with other clinical findings, may be useful in detecting malignant pleural effusions.