神经元特异性烯醇化酶、细胞角质蛋白19片断、癌胚抗原联合LDH、ADA检测对良、恶性胸腔积液鉴别的意义

目的探讨血清、胸水中神经元特异性烯醇化酶（NSE）、细胞角质蛋白19片断（CYFRA21—1）、癌胚抗原（CEA）对良、恶性胸腔积液的鉴别价值。方法对40例经病理确诊的胸腔积液患者按胸水的性质分为恶性胸水组（23例）和良性胸水组（17例）。2组患者均采用电化学发光法检测血清及胸腔积液中NSE、CYFRA21—1、CEA的含量．生化检测胸腔积液中乳酸脱氢酶（LDH）和腺苷脱氨酶（ADA）。结果恶性胸水组的血清NSE、CYFRA21—1及CEA均显著高于良性胸水组（P=O,02、0．02及0．01）;胸水CYFRA21—1及CEA均明显高于良性胸水组（严如．01或P=0．04）,ADA显著低于良性胸水组（P=0．01）。2组胸水NSE、LDH比较差异无统计学意义（均P〉O．05）。结论血清、胸腔积液中NSE、CYFRA21—1、CEA和ADA联合检测,对良、恶性胸腔积液的鉴别诊断有重要价值,能提高准确率。     

Diagnostic value of leptin in tuberculous pleural effusions

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.     

白细胞介素-18及血管内皮生长因子检测对结核性和恶性胸腔积液的鉴别诊断

目的:探讨白细胞介素-18(IL-18)及血管内皮生长因子(VEGF)检测在结核性和恶性胸腔积液鉴别诊断中的价值.方法:选择结核性胸腔积液52例设为结核组,恶性胸腔积液50例设为恶性组,分别采用酶显色法、酶免疫法检测胸腔积液中腺苷脱氨酶(ADA)、癌胚抗原(CEA)水平,采用双抗体夹心酶联免疫吸附(ELISA)法检测IL-18和VEGF水平.应用受试者工作特征(ROC)曲线计算上述指标和VEGF/IL-18比值的诊断敏感度、特异度、准确度及ROC曲线下面积.结果:结核组ADA、IL-18水平显著高于恶性组(P＜0.01);恶性组CEA、VEGF水平及VEGF/IL-18比值显著高于结核组(P＜0.01);IL-18诊断结核性胸腔积液的敏感度、特异度、准确度及ROC曲线下面积高于ADA(P＜0.05);VEGF/IL-18比值对恶性胸腔积液诊断的敏感度、特异度、准确度及ROC曲线下面积显著高于CEA和VEGF(P＜0.01).结论:IL-18和VEGF/IL-18比值可作为临床上鉴别结核性和恶性胸腔积液的良好指标.     

Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient). METHODS: From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity. RESULTS: There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests. CONCLUSIONS: The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.     

Concurrent measurement of adenosine deaminase and dipeptidyl peptidase IV activity in the diagnosis of tuberculous pleural effusion

Measurement of pleural fluid adenosine deaminase (ADA) levels aids diagnosing tuberculous pleural effusion (TPE). Dipeptidyl peptidase IV (DPP) enzyme is closely related to ADA. Our aim was to determine the value of concurrent measurement of these T-cell–associated enzymes, ADA and DPP levels in the diagnosis of TPE. Patients with pleural effusion were grouped as TPE, parapneumonic, malignant, congestive heart failure related, and miscellaneous pleural effusions. Pleural and serum ADA and DPP levels were measured. Pleural and serum levels of ADA and pleural DPP were higher in TPE group than the rest. In 7 patients, pleural biopsy revealed granulomatous pleuritis. All of these patients had TPE and had elevated serum and pleural ADA levels. Serum and pleural ADA or DPP levels and pleural ADA and DPP levels correlated with each other. Selecting cutoff values of 40 and 27 IU/L for pleural ADA and DPP, respectively, the sensitivity of concurrent measurement of both enzymes was 77%, specificity 94%, and diagnostic efficiency 91%. ADA and DPP play an important role in tuberculous immunopathogenesis. The utility of DPP in the diagnosis of TPE has never been determined before. Concurrent measurement of ADA–DPP can aid in diagnosing TPE with higher specificity, sensitivity, and efficiency.     

血管内皮生长因子、端粒酶、腺苷脱氨同工酶联合检测在胸腔积液鉴别诊断中的价值

目的探讨血管内皮生长因子(VEGF)、端粒酶、腺苷脱氨同工酶(ADA)联合检测在良恶性胸腔积液中的诊断价值。方法应用ELISA法检测VEGF的浓度、采用聚合酶联反应-酶联免疫吸附分析法(PCR-ELISA)检测胸腔积液端粒酶活性、用比色分析法检测胸腔积液ADA含量。结果恶性及结核性胸腔积液组VEGF值分别为(327±152)pg/L和(35±15)pg/L,结核组显著低于恶性组(P<0.01)。恶性胸腔积液中端粒酶活性显著高于结核性胸腔积液(P<0.01)。结核性胸液组ADA含量为(45.78±12.78)u/L,高于恶性胸液组(13.56±4.91)u/L,两者间差异有统计学意义。结论检测胸腔积液端粒酶、VEGF和ADA同工酶对癌性胸腔积液的诊断均有一定的价值,联合检测综合诊断能提高诊断准确率。     

多项指标联合检测在结核性与恶性胸腔积液鉴别诊断中的价值

目的探讨联合检测胸腔积液中的乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、C反应蛋白(CRP)和结核抗体(TB-Ab)在结核性与恶性胸腔积液鉴别诊断中的价值。方法将113例渗出性胸腔积液患者分为结核积液组(72例)和恶性积液组(41例),检测胸腔积液中的LDH、ADA、CRP和TB-Ab,并进行统计学分析。结果结核组胸腔积液中的ADA、CRP浓度和TB-Ab阳性率显著高于恶性积液组(P<0.01);结核组胸腔积液中LDH阳性率明显低于恶性积液组(P<0.01)。结论 进行胸腔积液中LDH、ADA、CRP和TB-Ab的联合检测在鉴别结核性与恶性胸腔积液中具有重要的临床价值。     

胸水中IL-18、IFN-γ和ADA检测对结核性和恶性胸水的鉴别诊断价值

[目的]探讨白细胞介素-18（IL-18）,γ-干扰素（IFN-γ）和腺苷脱氨酶（ADA）对结核性和恶性胸水的鉴别诊断价值.[方法]将胸水标本分为结核性胸水组和恶性胸水组,用酶联免疫吸附法（ELISA）检测IL-18和IFN-γ水平,用酶速率法检测ADA 水平.[结果] 结核性胸水组中IL-18、IFN-γ和ADA水平均显著高于恶性胸水组（P〈0.01）.IL-18界值为82.92 pg/mL时,敏感度为82.8%,特异性为92.3%.IFN-γ界值为50.78 pg/mL时,敏感度为82.8%,特异性为92.3%.ADA界值为38.35 U/L时,敏感度为82.8%,特异性为94.9%.[结论]胸水中IL-18、IFN-γ和ADA检测对结核性胸水和恶性胸水有鉴别诊断意义.     

3项联合检测在诊断结核性和恶性胸腔积液中的价值

目的测定胸腔积液和血清中腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)与癌胚抗原(CEA)的水平,探讨其指标联合检测对结核性和恶性胸腔积液的鉴别诊断意义。方法收集临床已确诊的86例胸腔积液患者(结核性48例,恶性38例)的胸腔积液和血清分别采用酶免疫法和化学发光法进行ADA、LDH和CEA含量测定。结果结核性胸腔积液ADA含量较恶性胸腔积液组明显增高(P0.01),CEA在恶性胸腔积液中含量较结核性胸腔积液组明显增高(P0.01)。3项指标联合检测敏感性为78.3%,特异性为93.7%,较单一指标的特异性高。结论联合检测ADA、LDH和CEA对不明原因的胸腔积液,在诊断和鉴别诊断上具有重要意义,能提高诊断准确率。     

探讨渗出性胸腔积液ADA、CEA对良恶性胸腔积液的诊断价值

目的 探究渗出性胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)对良恶性胸腔积液的诊断价值.方法 选择2017年1月至2020年8月本院收治的106例渗出性胸腔积液患者,将患者分为恶性组(n=36)和良性组(n=70).对两组患者胸水ADA、胸水CEA、血清CEA水平进行比较,采用单因素、多因素Logistic回归分析...     

胸水生化检查对结核性和恶性胸水的诊断价值

[目的]检测胸水中腺苷脱氨酶（adenosine deaminase,ADA）、乳酸脱氢酶（lactate dehydrogenase,LDH）、葡萄糖（Glucose,Glu）和总蛋白（total protein,TP）的水平,探讨其对结核性和恶性胸水的诊断价值。[方法]对所收集的标本进行胸水生化项目检测,并对结果统计分析。[结果]结核性胸水中ADA、TP含量明显高于恶性胸水,LDH和Glu明显低于恶性胸水,由ROC曲线得到ADA诊断结核性胸水最佳临界值为31．56U／L,此时灵敏度为77．2％,特异性为92．6％,当其值〉125U／L时,可以排除恶性胸水。[结论]联合检测有助于结核性和恶性胸水的诊断及鉴别诊断。     

联合检测ADA、LDH和CRP对结核性与恶性胸腔积液的诊断价值

目的探讨联合测定胸腔积液中的腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)和C反应蛋白(CRP)在结核性与恶性胸腔积液上鉴别诊断的价值。方法酶法和免疫比浊法检测59例结核性胸腔积液和17例恶性肿瘤积液中ADA、LDH和CRP的含量,并进行统计学分析。结果结核性胸腔积液中ADA和CRP水平显著高于恶性积液的值,具有统计学意义,P<0.01。但是,结核性胸腔积液中LDH含量低于恶性积液的LDH值,有显著性差异,P<0.01。结论胸腔积液中ADA、LDH和CRP的联合检测,对鉴别结核性与恶性胸腔积液有重要价值。     

胸水中CYFRA21－1测定的临床意义

利用ＢｏｅｈｒｉｎｇｅｒＭａｎｎｈｅｉｍ公司的ＣＹＦＲＡ２１－１酶免疫分析试剂盒，测定了已有明确诊断的１３０例胸腔渗漏液标本。结果表明，ＣＹＦＲＡ２１－１对于癌性胸水的诊断敏感性为６１．３％，特异性为８７．３％，准确度为７２．３％。若同时利用ＡＤＡ活性测定排除结核性胸膜炎，则其特异性可达９２．８％。揭示ＣＹＦＲＡ２１－１测定对胸水良恶性的诊断与鉴别诊断具有重要的临床价值。     

Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions

The response of the fibrinolytic system to inflammatory mediators in empyema and complicated parapneumonic pleural effusions is still uncertain. We prospectively analysed 100 patients with pleural effusion: 25 with empyema or complicated parapneumonic effusion, 22 with tuberculous effusion, 28 with malignant effusion and 25 with transudate effusion. Inflammatory mediators, tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and polymorphonuclear elastase, were measured in serum and pleural fluid. Fibrinolytic system parameters, plasminogen, tissue-type plasminogen activator (t-PA) and urokinase PA, PA inhibitor type 1 (PAI 1) and PAI type 2 concentrations and PAI 1 activity, were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test was used to compare plasma and pleural values and to compare pleural values according to the aetiology of the effusion. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid. Significant differences were found between pleural and plasma fibrinolytic system levels. Pleural fluid exudates had higher fibrinolytic levels than transudates. Among exudates, tuberculous, empyema and complicated parapneumonic effusions demonstrated higher pleural PAI levels than malignant effusions, whereas t-PA was lowest in empyema and complicated parapneumonic pleural effusions. PAI concentrations correlated with TNF-alpha, IL-8 and polymorphonuclear elastase when all exudative effusions were analysed, but the association was not maintained in empyema and complicated parapneumonic effusions. A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions. Blockage of fibrin clearance in empyema and complicated parapneumonic effusions was associated with both enhanced levels of PAIs and decreased levels of t-PA.     

渗出性胸腔积液135例诊断分析

目的 探讨腺苷脱氨酶(ADA)、癌胚抗原(CEA)、糖类抗原153(CA153)、神经元烯醇化酶(NSE)、糖类抗原199(CA199)对渗出性胸腔积液鉴别诊断的价值.方法 应用电化学发光法测定胸腔积液患者的血清及胸水CEA、CA153、NSE、CA199水平,采用酶偶联速率法测定胸水ADA水平,并评价联合检查对胸腔积液的诊断价值.结果 结核性胸腔积液组胸水ADA含量为(65.89±19.81)U/L,恶性组为(27.44±22.64)U/L,炎性组为(17.33±16.58)U/L,结核组显著高于其余2组(q=12.19、10.72,P均＜0.01).结性胸腔积液组ADA阳性29例(82.88%),恶性组11例(13.41%),炎性纽2例(11.11%),组间比较差异有统计学意义(X~2=59.07,P＜0.01).恶性胸腔积液组CEA、CA153、NSE、CA199含量和阳性率均高于结核组,差异均有统计学意义(P均＜0.05),炎性组和恶性组相比差异无统计学意义.82例恶性胸腔积液患者血清4项肿瘤标记物联检阳性率为74.3%(61/82),胸腔积液中阳性率为82.9%(68/82).结论 ADA、CEA、CA153、NSE、CA199联合检测对胸腔积液的鉴别诊断具有一定意义.     

髓系细胞触发受体-1和CRP在胸腔积液中的表达及意义

目的：探讨髓系细胞触发受体-1（TREM-1）、CRP在不同性质的胸腔积液中表达水平和意义。方法收集胸腔积液患者,检测胸腔积液和血清中TREM-1、CRP水平,检测胸腔积液细胞膜TREM-1 mRNA的表达。统计不同类型胸腔积液TREM-1、CRP表达水平的差异。结果（1）TREM-1检测显示：与结核性、肿瘤性和漏出性三组胸腔积液比较,肺炎旁胸腔积液sTREM-1表达显著增高。肺炎旁胸腔积液组血清sTREM-1与肿瘤性、漏出性胸腔积液组比较,表达均显著增高,但与结核性胸腔积液组比较无明显差异。（2）CRP检测显示：结核性和肺炎旁胸腔积液CRP水平均显著高于肿瘤性和漏出性胸腔积液。但结核性胸腔积液和肺炎旁胸腔积液CRP水平无显著差异。结核性胸腔积液组和肺炎旁胸腔积液组血清CRP水平均显著高于肿瘤性胸腔积液组和漏出性胸腔积液组,但结核性胸腔积液组和肺炎旁胸腔积液组血清CRP水平无显著差异。结论胸腔积液sTREM-1水平可以作为判断肺炎旁胸腔积液的重要参考指标。     

胸腔积液ADA、CRP和LAM-IgG联合检测的鉴别诊断价值

目的探讨胸腔积液腺苷脱氨酶(ADA)、C反应蛋白(CRP)、阿拉伯糖甘露糖脂抗体(LAM-IgG)联合检测对良恶性胸腔积液鉴别诊断的意义。方法以氨试剂法、散射比浊法和金标渗滤法同时检测了48例结核性胸水、27例癌性胸水和31例非结核炎性胸水的ADA、CRP和LAM-IgG。结果结核性胸水ADA、CRP活性明显高于癌性胸水(P<0.01),其它炎性胸腔积液CRP含量明显高于结核性和恶性胸腔积液(P<0.01);以ADA>30u/L,CRP>8mg/L,及LAM-IgG阳性等单个指标来诊断结核性胸腔积液,其敏感性达到95.7%,特异性为98.1%;以ADA<30u/L,CRP<8mg/L,及LAM-IgG阴性等单个指标来诊断恶性胸腔积液,其敏感性达到98.7%,特异性为97.1%。结论ADA、CRP、LAM-IgG联合检测可为良恶性胸腔积液的鉴别诊断提供可靠的实验室依据。     

胸膜厚度、腺苷脱氨酶、胸腔积液癌胚抗原/血清癌胚抗原比值对恶性与结核性胸腔积液的鉴别诊断价值

目的评价胸膜厚度、腺苷脱氨酶（ADA）、胸腔积液癌胚抗原/血清癌胚抗原（胸腔积液CEA/血清CEA）比值在恶性与结核性胸腔积液的鉴别诊断中的价值。方法选择经胸腔镜病理组织检查确诊胸腔积液患者91例,按病理结果分为2组,结核性胸膜炎组（结核性组）43例和恶性胸腔积液组（恶性组）48例。对2组患者胸腔积液CEA/血清CEA比值、ADA和CT影像学上表现的胸膜厚度、胸腔积液密度变化进行比较。结果恶性组胸腔积液CEA/血清CEA比值高于结核性组[6.72±6.9 vs 0.82±0.43（t=-3.832,P=0.001）,ADA水平低于结核性组（21.9±6.5）vs（50.3±31.9）U/L（t=4.474,P=0.000）];恶性组胸膜厚度〉10.0 mm且以弥漫型为主,结核性组胸膜厚度6.0 mm左右且以局限性为主;胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测的灵敏度、特异度、灵敏度/1-特异性（AUC）分别为90.0%、96.0%、0.869,均高于单检和2项联检,且3项联检的特异度与胸腔积液CEA/血清CEA＋ADA、胸膜厚度＋胸腔积液CEA/血清CEA联检的特异度比较差异均有统计学意义（均P〈0.05）。结论胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测对鉴别恶性与结核性胸腔积液有较高的临床价值。     

腺苷脱氨酶及C-反应蛋白检测对胸腔积液鉴别诊断的临床意义

目的探讨腺苷脱氨酶(ADA)及C-反应蛋白(CRP)检测对诊断结核性与癌性胸腔积液的价值。方法对临床确诊的93例结核性和56例癌性患者胸腔积液分别进行ADA及CRP的检测,并对结果进行比较分析。结果结核性患者胸腔积液ADA和CRP的水平含量分别为(51±7)U/L、(27.0±8.4)mg/L;癌性患者胸腔积液ADA和CRP的水平含量分别为(19±4)U/L、(14.0±5.7)mg/L,两者比较差异均有统计学意义(P<0.05)。结论 ADA及CRP检测在鉴别结核性和癌性胸腔积液方面具有较好的实用价值和临床意义。     

四联检测在结核性与恶性胸腔积液中的临床价值

目的探讨腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)和内皮抑素(Endostatin)对恶性及结核性胸腔积液鉴别诊断的价值。方法分别采用酶比色法测定ADA值;采用速率散射比浊法测定CRP浓度;采用酶联免疫吸附试验(ELISA)测定CEA和内皮抑素水平。并根据临床资料进行回顾性分析,对各组的ADA、CRP、CEA、内皮抑素水平进行比较。结果在结核性胸腔积液中,ADA[(54.73±20.17)U/L]和CRP[(32.48±19.17)mg/L]均明显高于癌性胸腔积液(P0.01);相反,在癌性胸腔积液中,CEA[(55.45±37.66)μg/L]与内皮抑素[(138.09±81.11)μg/L]的均值都显著高于结核性胸腔积液(P0.01)。结论ADA、CRP、CEA和内皮抑素四联检测在结核性与恶性胸腔积液中的鉴别诊断中具有显著的临床意义。