胸水ADA、CEA、CA125、CA153水平在结核性与恶性胸水中的表达与意义

目的探究机体胸腔积液内糖链抗原125(CA125)、癌胚抗原(CEA)、CA153、腺苷脱氨酶(ADA)表达情况及意义。方法选择2010年1月至2013年6月在该院就医的140例患者,基本资料齐全,经临床诊断,明确存在胸腔积液。按照胸水形成的病因不同,将研究对象分成两组,恶性胸腔积液组68例,结核性胸腔积液组72例,选择同期进行体检的健康人作为对照组130例。对三组人员进行血清CA125、CEA、CA153、ADA检测。结果恶性胸腔积液组中CEA、CA153显著高于结核胸腔积液组与对照组(P<0.05);恶性胸腔积液组CA125血清值显著低于结核性胸腔积液与对照组(P<0.05);三组CA125比较无统计学意义(P>0.05);在阳性参考值选择方面,数据标准为CA153>25 U/ml、ADA<35 U/L、CEA>10 ng/ml,诊断恶性胸腔积水的敏感度为92.7%,特异度约96.3%。结论在恶性胸腔积液患者中,CA153以及CEA水平明显升高;结核胸腔积液患者血清ADA值明显增高,但在诊断恶性胸腔积液时,ADA水平未发生显著变化,对各项胸水指标进行联合检测可大大提高确诊不同类型胸腔积液的特异度与敏感度。     

血清CRP及胸腔积液ADA、LDH、CEA联合检测在胸腔积液鉴别中的意义

联合检测36例恶性胸腔积液（恶性组）、27例结核性胸腔积液患者（结核组）血清C反应蛋白（CRP）及胸水腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）、癌胚抗原（CEA）水平,结果结核组血清CRP及胸腔积液ADA水平均显著高于恶性组（P均〈0.05）;而恶性组胸腔积液LDH、CEA水平均显著高于结核组（P均〈0.05）;血清CRP及胸腔积液ADA、LDH、CEA联合检测较单项检测敏感性、准确性及特异性均明显提高,其中血清CRP联合胸腔积液CEA、ADA检测诊断恶性积液敏感性、特异性最高。认为血清CRP及胸腔积液ADA、LDH、CEA联合检测对鉴别恶性、结核性积液有较好价值,以血清CRP联合胸腔积液CEA、ADA为佳。     

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。     

CA125、CEA、LDH、GLU、TBAb检测在胸腔积液中的价值

目的探讨胸腔积液患者胸腔积液CA125中CA125、CEA、LDH、GLU、TBAb这五项指标在胸积液性质鉴别诊断中的实用价值。方法将不同病因的胸腔积液患者115例分为结核性渗出液54例，恶性渗出液32例，化脓性渗出液29例。平行检测患者胸腔积液CA125中的五项指标。结果结核性胸腔积液CA125组TBAb（96．3％）阳性率明显高于恶性和化脓性胸腔积液CA125；化脓性胸腔积液CA125组LDH（1096±39．7）u／L明显高于恶性（594±34．6）u／L和结核性（638±31．9u／L）胸腔积液CA125组。化脓性胸腔积液CA125组GLU（2．91±0．56）mmol／L低于结核性和恶性胸腔积液CA125组；恶性胸腔积液CA125组CEA（87．3±12．6）ng／ml和CA125（98．3±29．6）u／ml明显高于化脓性和结核性胸腔积液CA125组。结论TBAb的检测对结核性胸腔积液CA125有较高的实用价值。LDH和GLU的联合检测对化脓性胸腔积液CA125有较大的价值。CA125和CEA的联合检测对恶性胸腔积液CA125有很大的实用价值。     

血清CA125测定在胸腔积液患者中的临床意义

目的检测不同原因引起的胸腔积液的血清肿瘤标志物CA125(癌胚抗原125)在胸腔积液患者中的临床价值。方法选择130例胸腔积液患者,检测所有患者血清CA125的浓度,分别按照疾病的良恶性、胸水量的大小、渗出液与漏出液分组,比较各组间患者浓度水平的差别。结果 130例胸腔积液患者中有123例血清CA125升高,阳性率为94.62%;恶性胸腔积液组与良性胸腔积液组相比血清CA125浓度有显著性差异(P0.05);大量胸腔积液组与中小量胸腔积液组、渗出液与漏出液之间相比,血清CA125浓度无显著性差异(P0.05)。结论血清CA125可作为鉴别良恶性胸腔积液的重要辅助指标,但其对量的大小及渗出液、漏出液的鉴别无临床应用价值。     

CEA和LDH联检对良恶性胸腔积液鉴别诊断价值的探讨

目的探讨癌胚抗原(CEA)、乳酸脱氢酶(LDH)对结核性胸水与恶性胸水的诊断鉴别意义。方法检测26例结核性胸腔积液患者和30例癌性胸腔积液患者的胸水与血清CEA、LDH含量进行对比分析。结果胸水CEA、LDH含量恶性组与结核组比较,差异有显著性意义(P<0.01)。血清CEA含量恶性胸水组与结核组比较,差异有显著性意义(P<0.01)。血清LDH含量,恶性组与结核组比较,差异无显著性意义(P>0.05)。结论胸水与血清中CEA、LDH含量对鉴别结核性和恶性胸水有一定的临床诊断价值,且CEA和LDH数值在胸水中变化更敏感。     

E-SLT、ADA、TB-Ab-IgG对老年结核性、癌性胸腔积液的诊断价值

目的探讨E-SLT、ADA、TB-Ab-IgG联合检测对老年结核性、癌性胸腔积液的诊断价值。方法对33例结核性胸膜炎、30例癌性老年胸腔积液患者、18例健康对照组分别进行ADA、TB-Ab-IgG检测及人可溶性E-SLT含量检测。结果结核组血清及胸腔积液中E-SLT水平均高于癌性组,且血清E-SLT水平均高于健康对照组;结核组血清及胸腔积液中ADA水平均高于癌性组,结核组中胸液/血清ADA1,在癌性组中胸液/血清ADA1。上述指标在各组间比较均有显著性差异(P0.05)。结论联合检测E-SLT、ADA、TB-Ab-IgG对结核性、癌性胸腔积液诊断有重要价值。     

PCT联合LDH检测对肺癌合并恶性胸腔积液的诊断价值

目的 评估胸腔积液中的降钙素原(PCT)、乳酸脱氢酶(LDH)水平检测对于肺癌合并恶性胸腔积液的诊断价值.方法 选取2015年1月至2017年2月在江阴市人民医院住院的胸腔积液患者,分为肺癌组和结核组,测定2组胸腔积液中PCT、LDH水平,并进行统计学分析.结果 肺癌组胸腔积液中PCT及LDH水平明显高于结核组(t值分别为7.298、5.607,P值均＜0.05).两者联合检测能够提高诊断的准确性.结论 联合检测PCT、LDH对于诊断肺癌合并恶性胸腔积液有重要的临床意义.     

六种细胞因子联合检测对结核性和恶性胸腔积液的鉴别诊断价值

目的探讨六种细胞因子联合检测对结核性和恶性胸腔积液的鉴别诊断价值。方法前瞻性分析本院因胸腔积液住院的患者96例,根据患者原发病症将患者分为结核性胸腔积液组(结核组)和恶性胸腔积液组(恶性组),比较两组患者的细胞因子含量差异,统计各因子对结核性胸腔积液和恶性胸腔积液的敏感性、特异性、准确性。结果结核组患者女性比例较高,恶性组患者的年龄较高;结核组患者的IL-6,IL-4,TNF-α,IFN-γ的含量较高;细胞因子对于结核性胸腔积液的敏感性IFN-γ最高,特异性IFN-γ最高,准确性IFN-γ最高;多个因子共同检测诊断可以有效提升诊断结核性胸腔积液的敏感性、特异性和准确性。结论将细胞因子联合检测应用于结核性胸腔积液和恶性胸腔积液的鉴别诊断,操作方便、速度快以及诊断结果准确。     

Transforming growth factor beta-1 level in pleural effusion

OBJECTIVE: Transforming growth factor-beta1 is an important immunomodulator. The diagnostic role of TGF-beta1 has not been systematically investigated in pleural effusion. METHODOLOGY: A prospective clinical study of 45 patients (23 men, 22 women; mean age 49 +/- 21 years) with pleural effusion was performed. Of these patients, 19 had malignant pleural effusion, 14 had tuberculous pleural effusion, seven had empyema/parapneumonic pleural effusion, and five had transudative pleural effusion due to congestive heart failure. The concentrations of TGF-beta1 were measured by ELISA in all pleural fluid samples and in serum samples only from patients with malignant and tuberculous pleural effusions. RESULTS: The median TGF-beta1 levels of malignant, tuberculous and empyema/parapneumonic pleural effusions were 7.25 ng/mL, 7.81 ng/mL, and 9.75 ng/mL, respectively. There was no significant difference between them. The median TGF-beta1 level was 5.62 ng/mL in the transudate pleural effusion group and it was significantly lower than that in the empyema/parapneumonic group (P < 0.05). The pleural fluid TGF-beta1 levels did not correlate with cell profiles of the pleural fluid. The median serum TGF-beta1 levels in malignant and tuberculous pleural effusion groups were 7.38 ng/mL and 7.38 ng/mL, respectively. There was no significant difference between the levels of TGF-beta1 in paired samples of serum and pleural fluid. CONCLUSIONS: This study shows that TGF-beta1 concentrations in exudative pleural effusions are higher than those in transudative effusions secondary to congestive heart failure but TGF-beta1 concentrations do not assist in differentiating exudative effusions.     

细胞角质蛋白19片段与癌胚抗原联合检测对良恶性胸腔积液的鉴别诊断价值探讨

目的探讨细胞角质蛋白19片段(CYFRA21-1)与癌胚抗原(CEA)检测对结核性胸水与癌性胸水的鉴别诊断价值?方法对胸水患者108例(癌性68例?结核性40例)分别测定其血清?胸水中CYFRA21-1和CEA浓度?结果1.两种肿瘤标记物浓度在恶性胸水中明显高于结核性胸水;2.癌性胸水中CYFRA21-1浓度明显高于血清浓度,而胸水中CEA浓度与血清中浓度相比无显著性差异;3.胸水CYFRA21.1的检测结果存在一定的假阳性?结论联合检测CYFRA21-1与CEA对胸水良恶性的鉴别诊断有较高的临床价值?     

Vasoactive mediators (VEGF and TNF-alpha) in patients with malignant and tuberculous pleural effusions

OBJECTIVE: Vascular endothelial growth factor (VEGF) is a potent endothelial cell-specific mitogen that promotes angiogenesis, vascular hyperpermeability, and vasodilatation by autocrine mechanisms involving nitric oxide (NO). This study was undertaken to determine the potential role of VEGF in the pathogenesis of pleural effusions, and its relationship with tumour necrosis factor (TNF)-alpha and NO in the pleural fluid and serum of patients with tuberculous and malignant pleural effusions. METHODOLOGY: Pleural fluid and serum (SE) VEGF, TNF-alpha and NO levels were measured in 30 patients with exudative pleural effusion (15 with malignancies and 15 with tuberculosis). Control pleural fluid was obtained from 10 patients with transudative pleural effusion due to congestive heart failure and control serum samples were obtained from 10 healthy individuals. VEGF and TNF-alpha were measured by enzyme-linked immunosorbent assay and NO by a colorimetric method. Pleural biopsy, cytology or microbiological methods were used to make the final diagnosis. RESULTS: In patients with exudative pleural effusions, the mean pleural fluid and serum VEGF levels and their ratios (P < 0.0001 for all) and TNF-alpha levels (P < 0.01, P < 0.0001 and P < 0.05) were significantly elevated compared to those with transudative pleural effusion. In malignant effusions, pleural fluid and serum VEGF levels were significantly elevated (P < 0.001 and P < 0.0001) while pleural fluid, and serum levels and their ratios of TNF-alpha (P < 0.001, P < 0.01 and P < 0.05) were significantly lower than those in tuberculosis. NO levels did not distinguish between tuberculous and malignant effusions. CONCLUSIONS: In patients with malignant pleural effusions, levels of VEGF were significantly higher, while levels of TNF-alpha were significantly lower, than in patients with tuberculous effusions. In malignant pleural effusions, the elevated pleural fluid levels of VEGF and TNF-alpha are noteworthy. Our data support the hypothesis that blockade of VEGF, might benefit cancer patients with recurrent ascites or pleural fluid accumulation.     

Diagnostic value of interleukin-1alpha, interleukin-6, and tumor necrosis factor in pleural effusions

STUDY OBJECTIVES: Interleukin (IL)-1alpha, IL-6, and tumor necrosis factor (TNF)-alpha were measured in pleural fluid from 57 patients with pleural effusion in order to evaluate the diagnostic utility of these cytokines. We studied 20 patients with malignant pleural effusion, 11 patients with parapneumonic pleural effusion, 9 patients with tuberculous pleural effusion, and 17 patients with transudative pleural effusion. Cytokines were measured by radioimmunoassay. SETTING: University tertiary hospital. RESULTS: The mean values of the three cytokines measured in pleural fluid or in serum were significantly higher in patients with exudates than with transudates (p < 0.05). The ratio of IL-6 in pleural fluid to serum was significantly higher in exudates than in transudates (p < 0.05). The level of IL-6 in pleural fluid was significantly higher in tuberculous than malignant (p < 0.007) or parapneumonic pleural effusions (p < 0.04). No significant difference between the three types of exudates was found in pleural fluid levels of IL-1alpha or TNF-alpha. CONCLUSIONS: Serum levels of IL-1alpha, TNF-alpha, and in particular IL-6 can distinguish exudates from transudates, while pleural fluid IL-6 levels could be useful as an additional marker in the differential diagnosis of tuberculous, malignant, and parapneumonic exudates. Finally, our results suggest that there is local cytokine production in exudative pleural effusions.     

Determination of adenosine deaminase activity and its isoenzymes for diagnosis of pleural effusions

OBJECTIVE: We aimed to investigate adenosine deaminase (ADA) activity and the activities of its ADA1 and ADA2 isoenzymes in pleural effusions and also sera with different aetiological origins. METHODOLOGY: The pleural effusions of 87 patients were examined. The patients were separated into four groups: transudates, parapneumonic, malignant, and tuberculous effusions. The cases were also designated as tuberculous or non-tuberculous group. Adenosine deaminase activity was determined by the colorimetric method described by Giusti and Galanti. RESULTS: The intermean differences were statistically significant for total ADA, ADA1 and ADA2, except for pleural fluid ADA1 in the malignant group when compared to the tuberculous effusion group. The intermean differences between the tuberculous and non-tuberculous group were statistically significant for all three parameters except for pleural fluid and serum ADA1 activity. The sensitivities of total ADA, ADA1 and ADA2 activities for tuberculosis were 91, 57 and 93%, respectively; their specificities 89, 88 and 92%, respectively; their positive predictive values 82, 70 and 86%; and their diagnostic accuracies 89, 76 and 92%, respectively, in pleural fluid. CONCLUSIONS: Determination of ADA and its isoenzymes can help to differentiate the causes of pleural effusion. Increased ADA2 activity is a striking marker of tuberculous effusions. In contrast, increased ADA1 activity was significantly elevated in parapneumonic effusions.     

High level of interferon gamma in tuberculous pleural effusion

It has been observed that T-lymphocytes of patients with tuberculosis produce interferon gamma (IFN gamma) in vitro. Based on this idea, we studied IFN gamma in pleural fluid and serum. We studied 80 patients with pleural effusion; 30 patients with tuberculous pleurisy had high IFN gamma concentrations in pleural fluid. Patients with malignant pleural effusions, nonspecific pleural effusion, parapneumonic effusions and pleural transudates had low levels. The IFN gamma levels were higher in those with massive tuberculous effusion and apparent pulmonary lesion on x-ray film. We found that the T4/T8 lymphocyte ratio was higher in pleural fluid than in peripheral blood. Numbers of T3 and T4 lymphocytes were higher in tuberculous pleural effusions compared with those in other patients. There is no correlation between IFN gamma levels and lymphocyte subsets in pleural effusion. Perhaps pleural T-lymphocytes produce IFN gamma after stimulation by mycobacterial antigens and this lymphokine activates macrophages, increasing their bactericidal activity against Mycobacterium tuberculosis.     

Clinical significance of serum CA125 in patients with tuberculous pleurisy

We measured CA125 levels of the sera and pleural effusions in both patients with tuberculous pleurisy (TB) and with benign non-tuberculous pleurisy (non-TB). In all the TB patients, serum CA125 levels were increased (78 to 370 U/ml, mean +/- SD = 167.3 +/- 96.8 U/ml, n = 8), and were significantly higher than those in non-TB patients (167.3 +/- 96.8 U/ml v.s. 36.9 +/- 18.4 U/ml, p less than 0.01). Neoplastic diseases or gynecological disorders were not found in these patients. On the other hand, either CA125 or LDH levels of pleural effusions were not significantly different between these two groups. Although adenosine deaminase (ADA) levels in pleural effusions were also significantly higher in the TB patients (p less than 0.05), there were no correlation between serum CA125 and ADA levels in pleural effusions. Serial measurement of serum CA125 levels in the TB patients revealed that serum CA125 levels were markedly decreased one to two months after anti-tuberculous therapy (172.6 +/- 103.3 U/ml to 23.3 +/- 9.9 U/ml, p less than 0.01). It is suggested that the measurement of serum CA125 in patients with tuberculous pleurisy is useful as an indicator of disease activity.     

Proinflammatory cytokines and fibrinolytic enzymes in tuberculous and malignant pleural effusions

OBJECTIVES: To measure tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in pleural effusions caused by tuberculosis (TB) and malignancy and their relationship with plasminogen activator inhibitor type I (PAI-1) and tissue type plasminogen activator (tPA), and to compare the differences between tuberculous and malignant pleural effusions. In addition, the relationship between the effusion levels of these parameters and the development of residual pleural thickening was evaluated in the patients with tuberculous pleurisy. DESIGN: Prospective study. MATERIALS AND METHODS: TNF-alpha, IL-1beta, PAI-1, and tPA were measured simultaneously in blood and pleural fluid using an enzyme-linked immunosorbent assay in 33 patients with tuberculous and in 30 patients with malignant pleural effusions. Residual pleural thickening was measured and defined as a pleural thickness of >/= 10 mm found on chest radiographs at the completion of anti-TB chemotherapy in tuberculous pleurisy patients. RESULTS: In both groups, the levels of proinflammatory cytokines and fibrinolytic enzymes were significantly higher in pleural fluid than in blood. The levels of TNF-alpha and PAI-1 were significantly higher in tuberculous than in malignant effusions. In contrast, malignant pleural fluid had significantly higher values of tPA than did tuberculous pleural fluid. In tuberculous effusions, the values of PAI-1 and the PAI-1/tPA ratio correlated positively and the levels of tPA correlated negatively with those of TNF-alpha and IL-1beta. In malignant pleural fluid, positive correlations were found between the values of proinflammatory cytokines (TNF-alpha and IL-1beta) and PAI-1. Residual pleural thickening was found in 9 of 33 patients (27. 3%) with tuberculous pleurisy. The pleural fluid values of TNF-alpha, IL-1beta, and PAI-1 were significantly higher and the concentrations of tPA were significantly lower in tuberculous pleurisy patients with residual pleural thickening. CONCLUSIONS: Compared to malignant pleural effusion, fibrinolytic activity in pleural fluid was reduced in tuberculous effusion. Pleural inflammation caused by TB may enhance the release of proinflammatory cytokines, particularly TNF-alpha, which subsequently may increase PAI-1 and decrease tPA in pleural fluid. The imbalance of PAI-1 and tPA in pleural space may lead to fibrin deposition and pleural thickening.     

C反应蛋白在结核性及恶性胸腔积液鉴别诊断中的价值

目的　探讨 C反应蛋白 (CRP)测定在结核性及恶性胸腔积液鉴别诊断中的价值。方法　对 32例结核性或恶性胸腔积液患者的胸水、血清 CRP浓度及胸水 CRP/血清 CRP进行对比分析。结果　结核性胸液组胸水CRP浓度、血清 CRP浓度、胸水 CRP/血清 CRP均高于恶性胸液组 (分别为 P<0 .0 0 1,P<0 .0 1,P<0 .0 5 )。结论　 CRP测定有助于对结核性与恶性胸腔积液的鉴别。     

胸水CA125水平测定对结核性胸腔积液的临床意义

目的：观察胸水糖类抗原125（CA125）水平对结核性胸腔积液的临床意义。方法将2008-01～2014-01该院确诊为结核性胸膜炎并行胸水CA125测定的30例患者作为观察组,将确诊为肺炎旁胸腔积液或自身免疫性疾病合并胸腔积液的30例患者作为对照组,比较两组患者胸水CA125水平检测结果。结果观察组胸水CA125＜68.6 U／ml 3例,68.6 U／ml≤CA125≤600 U／ml 17例,＞600 U／ml 10例;对照组胸水CA125＜68.6 U／ml 1例,68.6 U／ml≤CA125≤600 U／ml 28例,＞600 U／ml 1例。两组比较差异具有统计学意义（ P＜0.01）。结论胸水CA125水平测定对结核性胸腔积液的诊断有一定的临床意义。