结核性与恶性胸腔积液中ADA、CEA及CA-199应用价值探讨

胸腔积液中以结核及恶性肿瘤最为多见,临床上有时较难鉴别,我们对122例结核性胸腔积液及44例恶性胸腔积液中腺苷脱氨酶（ADA）、癌胚抗原（CEA）、糖类抗原199（CA-199）活性进行联检,以探讨其在鉴别结核性与恶性胸腔积液中的临床应用价值。     

联合检测IFN-γ、VEGF-C、CRP及ADA对结核性与恶性胸腔积液鉴别诊断的价值

目的探讨干扰素-γ(IFN-γ)、血管内皮生长因子(VEGF-C)、C-反应蛋白(CRP)及腺苷脱氨酶(ADA)在结核性与恶性胸腔积液鉴别诊断中的应用价值。方法检测122例临床确诊的胸腔积液患者(恶性胸腔积液56例,结核性胸膜炎48例,其他类型18例)胸水和血清中的IFN-γ、VEGF-C、CRP及ADA含量。结果结核组的IFN-γ、CRP浓度及ADA活性明显高于恶性肿瘤组,差异有统计学意义(P0.01),根据受试者工作特征(ROC)曲线结果判断,以100ng/L为临界值,IFN-γ对结核性胸腔积液诊断的灵敏度、特异性分别为83.1%、92.3%;以45U/L为临界值,ADA对结核性胸腔积液诊断的灵敏度、特异性分别为85.6%、96.3%;以110mg/L为临界值,CRP对结核性胸腔积液诊断的灵敏度、特异性分别为79.1%、84.2%;三项指标联合检测,其灵敏度、特异性分别达到87.8%和86.0%。恶性胸腔积液中VEGF-C高于结核性及其他类型胸腔积液(P0.01);VEGF-C/ADA≥8对恶性胸腔积液诊断的灵敏度、特异性分别为86.3%、82.6%;VEGF-C/ADA≤3对结核性胸腔积液诊断的灵敏度、特性度分别为85.1%、87.1%。结论联合检测IFN-γ、VEGF-C、CRP及ADA可以提高结核性胸膜炎诊断的灵敏度及特异性,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。     

Value of Combined Detection of Interferon-γ, Vascular Endothelial Growth Factor, C-reactive Protein and Adenosine Deaminase in Differential Diagnosis of Tuberculous and Malignant Pleural Effusion

目的 探讨干扰素-γ(IFN-γ)、血管内皮生长因子(VEGF-C)、C-反应蛋白(CRP)及腺苷脱氨酶(ADA)在结核性与恶性胸腔积液鉴别诊断中的应用价值.方法 检测122例临床:确诊的胸腔积液患者(恶性胸腔积液56例,结核性胸膜炎48例,其他类型18例)胸水和血清中的IFN-γ、VEGF-C、CRP及ADA含量.结果 结核组的IFN-γ、CRP浓度及ADA活性明显高于恶性肿瘤组,差异有统计学意义(P＜0.01),根据受试者工作特征(ROC)曲线结果判断,以100ng/L为临界值,IFN-γ对结核性胸腔积液诊断的灵敏度、特异性分别为83.1％、92.3％;以45U/L为临界值,ADA对结核性胸腔积液诊断的灵敏度、特异性分别为85.6％、96.3％;以110mg/L为临界值,CRP对结核性胸腔积液诊断的灵敏度、特异性分别为79.1％、84.2％;三项指标联合检测,其灵敏度、特异性分别达到87.8％和86.0％.恶性胸腔积液中VEGF-C高于结核性及其他类型胸腔积液(P＜0.01);VEGF-C/ADA≥8对恶性胸腔积液诊断的灵敏度、特异性分别为86.3％、82.6％;VEGF-C/ADA≤3对结核性胸腔积液诊断的灵敏度、特性度分别为85.1％、87.1％.结论 联合检测IFN-γ VEGF-C、CRP及ADA可以提高结核性胸膜炎诊断的灵敏度及特异性,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.     

胸腔积液中肿瘤坏死因子和腺苷脱氨酶含量对结核性胸？…

目的;探讨肿瘤坏死因子和腺苷脱氨酶对结核性胸膜炎的诊断价值。方法：ＡＤＡ采用比色法,ＴＮＦ采用ＥＬＩＳＡ法对２７例恶性胸腔积液,５２例结核性胸腔积液进行了检测。结果：结核性胸腔积液ＡＤＡ和ＴＮＦ水平都明显高于恶性胸腔积液,差别具有显著性。结论：应用ＴＮＦ和ＡＤＡ可能有助于结核性胸膜炎的鉴别诊断。     

210例针刺胸膜活检分析

目的研究针刺胸膜活检在胸腔积液病因诊断中的价值和安全性。方法对2000年12月至2007年12月间诊断明确且做过1次以上胸膜活检的210例胸腔积液患者的临床资料进行回顾分析。结果210例胸腔积液中结核性胸膜炎102例，恶性胸膜炎60例，两者胸膜活检的阳性率分别为66．7％（68／102）和69．7％（60／86）。术后并发症主要为：气胸34．9％（105／301）、出血11．6％（35／301）、术后发热12-3％（37／301）、胸膜反应7．3％（22／301）、肿瘤细胞针道种植1．0％（3／301），未出现致命并发症。结论在结核性及恶性胸腔积液的诊断中，针刺胸膜活检是一种有效而又安全的手段，多次活检可提高确诊率。     

胸水中 CA125、TSGF及ADA检测在结核性、恶性胸腔积液鉴别诊断中的应用研究

目的:分析胸水中糖类抗原125(Carbohydrate antigen 125,CA125)、肿瘤生长因子(Tumor associated growth factor,TSGF)及腺苷脱氨酶(Adenosine deaminase,ADA)检测在结核性、恶性胸腔积液鉴别诊断中的应用价值.方法:选取2018年2月-2020年2月本院收治的存在胸腔积液患者82例[结核性胸腔积液(结核组)43例,恶性胸腔积液(恶性组)39例].对比两组CA125、TSGF及ADA表达水平,分析CA125、TSGF及ADA对胸腔积液的诊断价值.结果:结核组CA125水平明显低于恶性组,TSGF、ADA水平则明显高于恶性组(P<0.05);CA125、TSGF及ADA联合诊断对结核性胸腔积液诊断特异度为83.72％,敏感度为76.92％,明显高于三者单独诊断(P<0.05);CA125、TSGF及ADA三者联合对结核性胸腔积液诊断特异度分为82.05％,敏感度为76.92％,明显高于三者单独诊断(P<0.05).结论:胸水中CA125、TSGF及ADA检测可为结核性、恶性胸腔积液鉴别诊断提供参考依据,三者联合检测可提高临床对胸腔积液性质鉴别准确性.     

结核性胸腔积液患者ADA检测的临床意义

胸腔积液（简称胸水）在临床上较为常见,检测方法繁多,根据症状很难鉴别。随着腺苷脱氨酶（ADA）检测在临床上的应用,许多学者认为胸水ADA活性检测对结核性胸膜炎的诊断和抗结核疗效观察具有肯定的临床意义。本文对100例胸腔积液患者胸水ADA活性进行了检测,以探讨其临床意义。     

Fer、CEA、Glu、ADA联检在结核性和癌性浆膜腔积液鉴别诊断上的价值

恶性肿瘤和结核性胸膜炎、腹膜炎患者常伴有胸腹腔积液等症状。鉴别胸腹腔积液的性质对疾病的辅助诊断有重要价值,且可影响到患者的治疗和预后。细胞学检查是诊断良恶性胸腹腔积液特异性最好的方法,但敏感性仅50％左右。通过对浆膜腔积液中铁酯白（Fer）、癌胚抗原（CEA）、葡萄糖（Glu）和腺苷脱氨酶（ADA）四个项目检测,以探讨其在鉴别浆膜腔积液性质中的价值。     

ADA和CRP联合测定在胸腔积液鉴别中的应用

胸腔积液是一种临床常见的胸膜病变,其发生的原因有很多,其中以结核性胸腔积液和恶性胸腔积液最常见,病因的确诊一直较为困难,缺乏简单快速的诊断方法。传统的诊断学方发法主要依靠细菌学、细胞学和胸膜活检来确诊,上述诊断方法阳性率不高,且活检有一定的危险性,往往不为医患双方接受。因而结核性胸腔积液的早期诊断较为困难。本文分析了我院2004年1月到2008年6月的203例病因明确的胸腔积液患者,通过联合检测胸水中的腺苷脱氨酶（ADA）和C反应蛋白（CRP）的活性,旨在探讨胸水中ADA和CRP的活性在结核性和恶性胸腔积液中的鉴别诊断价值     

胸腔积液／血清CEA、Fer、ADA、LDH联检在鉴别恶性和结核性胸腔积液中的价值

胸腔积液在临床上很常见，有时以结核性和恶性肿瘤为病因，为了更好地对两者进行鉴别诊断，我院选用癌胚抗原（CEA）、铁蛋白（Fer）、腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）等指标对恶性胸腔积液和结核性胸腔积液进行检测，并取得良好的效果。现将结果报道如下。     

Superoxide dismutase 2 as a marker to differentiate tuberculous pleural effusions from malignant pleural effusions

OBJECTIVES:Our previous study demonstrated that superoxide dismutase levels were higher in tuberculous pleural effusions than in malignant pleural effusions, but that this difference could not be used to discriminate between the two. The objective of the present study was to investigate the levels of superoxide dismutase 2 in pleural effusions and to evaluate the diagnostic significance of pleural effusion superoxide dismutase 2.METHODS:Superoxide dismutase 2 concentrations were determined in pleural effusions from 54 patients with tuberculous pleural effusion and 33 with malignant pleural effusion using an enzyme-linked immunosorbent assay (ELISA) kit. Pleural effusion interferon gamma and tumor necrosis factor alpha levels were also analyzed by ELISA. The Mann-Whitney U test was used to evaluate the significance of differences. Associations between superoxide dismutase 2 concentrations and sex, age and smoking habits were assessed using Spearman''s or Pearson''s correlation coefficient analysis. Receiver operator characteristic analysis was performed to evaluate the value of superoxide dismutase 2 levels in the discrimination of tuberculous pleural effusion from malignant pleural effusion.RESULTS:Superoxide dismutase 2 levels were significantly higher in patients with tuberculous pleural effusion compared with those with malignant pleural effusion (p<0.05). When superoxide dismutase 2 was used to differentiate between tuberculous pleural effusions and malignant pleural effusions, the area under the receiver operator characteristic curve was 0.909 (95% confidence interval, 0.827-0.960; p<0.01). With a cut-off value of 54.2 ng/mL, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 75.8% (95%CI: 57.7-88.9%), 98.1% (95%CI: 90.1-99.7%), 40.91 and 0.25, respectively. Furthermore, significant correlations between pleural effusion superoxide dismutase 2 and interferon gamma (r = 0.579, p<0.01) and between pleural effusion superoxide dismutase 2 and tumor necrosis factor alpha (r = 0.396, p<0.01) were observed.CONCLUSION:Pleural effusion superoxide dismutase 2 can serve as a biomarker for differentiating between tuberculous pleural effusions and malignant pleural effusions. Because of the high correlations of superoxide dismutase 2 with pleural effusion interferon gamma and tumor necrosis factor alpha levels, this marker may act as an inflammatory factor that plays an important role in the development of tuberculous pleural effusion.     

Vascular endothelial growth factor in malignant and tuberculous pleural effusions

The purpose of this study is to assess the usefulness of soluble vascular endothelial growth factor (VEGF) in the effusions of patients with malignant and tuberculous diseases. Using a sandwich enzyme-linked immunoadsorbent assay, VEGF concentration was measured in malignant (n=17) and tuberculous (n=11) pleural effusions. Pleural biopsy, cytology or microbiological methods were used to make final diagnoses. Adenosine deaminase (ADA) levels in tuberculous pleural effusions were significantly higher than those in malignant pleural effusions. The median level of VEGF in patients with malignant effusions (median, 2418 pg/mL; range, 97-62103 pg/mL) was significantly higher than tuberculous effusions (median, 994 pg/mL; range, 44-3552 pg/mL). There were no significant differences in pleural VEGF levels in patients with different histological types of lung cancer. The VEGF level was not correlated with ADA, lactate dehydrogenase and total protein levels of pleural fluid. In conclusion, pleural VEGF levels in patients with malignant effusions were significantly higher than tuberculous effusions, and the measurement of pleural VEGF is helpful in discriminating between malignant and tuberculous effusions. Further studies are needed to determine the clinical value of VEGF as a tumor marker and a prognostic factor.     

Crucial Role of CD4+CD 25+ FOXP3+ T Regulatory Cell,Interferon-γ and Interleukin-16 in Malignant and Tuberculous Pleural Effusions

The differential diagnosis between malignant and tuberculous exudative pleural effusions is an important clinical problem. The aim of current study is to evaluate the frequencies of T-regulatory cells (Treg) on the basis of distinct phenotypes in the differential diagnosis between malignant and tuberculous pleural effusion. In addition, to evaluate Interferon-gamma (IFN- γ) and interleukin-16 (IL-16) levels and their correlation to Treg cells in malignant and tuberculous pleural effusions. Sixty patients with pleural effusion (26 tuberculous and 34 malignant) and 20 healthy controls were included in the study. Pleural fluid and peripheral blood were assessed for frequencies of T regs, IL-16, and IFN-γ. Pleural effusions from both tuberculous and malignant groups represented significantly higher levels (more in TB) for the following cell populations than peripheral blood: total lymphocytes, CD3+lymphocyte, CD4+CD25+lymphocyte and Treg (CD4+ CD25+FoxP3+). Levels of IL-16 and IFN-γ in tuberculous group were significantly higher than that in malignant group. Regulatory T cells, INF-γ and IL-16 are new important tools for differentiation between tuberculous and malignant pleural effusion.     

ADA、ACE、LDH、CEA的联合检测在结核性和恶性胸腔积液中的鉴别诊断价值

目的测定血清和胸水中腺苷脱氨酶（ADA）、血管紧张素转化酶（ACE）、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水的鉴别诊断意义。方法对临床已确诊的72例胸腔积液患者（结核性40例,恶性32例）的胸水和血清分别采用酶免疫法和化学发光法进行ADA、ACE、LDH和CEA含量测定。结果结核性胸水中ADA的含量为（60.2±20.10）U/L,ACE的含量为（35±9.6）U/L,LDH的含量为（338±41）U/L,CEA的含量为（12.8±5.82）μg/L;在恶性胸水中,ADA为（11.02±5.23）U/L,ACE为（16±11.0）U/L,LDH为（379±69.0）U/L,CEA为（39.9±19.7）μg/L。结核性胸水ADA和ACE含量较恶性胸水组明显增高（P〈0.01）,CEA在恶性胸水中含量较结核性胸水组明显增高（P〈0.01）。胸水中ADA和ACE的检测对结性性胸膜积液诊断的敏感性分别为84.3%、87.5%,特异性分别为87.5%、80.0%;而胸水中LDH和CEA的检测对恶性胸膜积液诊断的敏感分别为84.3%、75.0%,特异性分别为80.0%、93.0%。四项指标联合检测敏感性性为78.1%,特异性为97.5%,较单一指标的特异性高。结论胸水中ADA、ACE、LDH和CEA的联合检测对结核性和恶性胸水的鉴别诊断具有一定价值,有助于临床胸水性质的诊断。     

血清及胸水中ADA、IL-2、IL-6、IL-10联检对结核性和癌性胸膜炎患者的诊断价值

目的:观察结核性和癌性胸膜炎两组患者血清和胸水ADA、IL-2、IL-6、IL-10的含量变化,能成为鉴别诊断试验。方法:结核性胸水组56例、癌性胸水组53例、正常对照组30例,分别测定血清和胸水中ADA、IL-2、IL-6、IL-10,并进行临床诊断的ROC曲线分析。结果:两组患者血清IL-6水平明显高于对照组,有显著性差异(P<0 05),结核性胸水组的ADA、IL-2、IL-6、IL-10明显高于癌性组,有显著差异(P<0 05),ROC曲线表明两组依次为ADA>IL-10>IL-6>IL-2。结论:胸水的ADA、IL-2、IL-6、IL-10的测定有助于两组的鉴别诊断,总的鉴别诊断价值依次为ADA>IL-10>IL-6 >IL-2,并且ADA与IL-10的联检可明显提高两组胸水的鉴别诊断价值。     

CEA、CYFRA21-1和NSE联检对恶性胸腔积液的诊断价值

目的：探讨CEA、CYFRA21-1和NSE联检对恶性胸腔积液的诊断价值。方法：采用放射免疫分析检测了40例恶性胸腔积液（恶性组）和32例结核性胸腔积液（结核组）血清和胸腔积液的CEA、CYFRA21-1和NSE的水平并计算其胸腔积液/血清（P/S）比值。结果：恶性胸腔积液组中胸腔积液CEA、CYFRA21-1和NSE水平及P/S比值明显高于结核组（P〈0.01）。CEA、CYFRA21-1和NSE单项检测恶性胸腔积液特异性最高的为CEA（90）,敏感性最高为CYFRA21-1（83）。CEA、CYFRA21-1和NSE三项联检对恶性胸腔积液的敏感性为90,特异性为89。结论：CEA、CYFRA21-1和NSE三项肿瘤标志物联检可明显提高恶性胸腔积液的阳性诊断率,对恶性胸腔积液的诊断有较高的临床应用价值。     

Diagnostic value of serum and pleural fluid adenosine deaminase activity in tuberculous pleurisy

The biological diagnosis of tuberculous pleurisy poses the problem of the time required to obtain results and of the sensitivity of the usual diagnostic methods. The determination of adenosine deaminase (ADA) activity has been proposed for the diagnosis of tuberculous pleural effusion and for the follow-up. In the present study, ADA in pleural effusion (p-ADA) and in serum (s-ADA) has been measured in 2 groups of patients: tuberculosis (27) and non-tuberculosis (53) patients. The upper limit of the normal values was fixed at 37 U/L. Comparing these 2 groups, we observed a specificity of 81.2% and a sensitivity of 66.6%. The PPV and the NPV were respectively 64.3% and 82.7%. We used p-ADA/s-ADA ratio for diagnosis of tuberculous pleural effusion, a threshold value of 1.8 gave a sensitivity of 82.6% and a specificity of 84.8%. Within the tuberculosis patient group, the activity of ADA decreased after the appropriate treatment initiation. Thus, the determination of ADA activity and/ or the p-ADA/s-ADA ratio, can help to recognize the tuberculosis origin of pleural effusions.     

Activities and isozymes of adenosine deaminase and lactate dehydrogenase in tuberculous pleural effusion with special reference to the presence of mycobacterium tuberculosis]

We have previously shown that tuberculous pleurisy possesses a high level of adenosine deaminase (ADA) which is predominantly composed of ADA2. In this paper, we report the cases of tuberculous pleural effusion which contained mainly ADA1. In these cases, mycobacterium tuberculosis was positive by smear examination and/or culture and granulocytes were found to be major components. Analysis of lactate dehydrogenase (LDH) revealed that its activity was high and LDH5 occupied about 50% of total activity. In the tubercle bacillus negative cases, lymphocytes were the main components and the levels of LDH containing mostly LDH3 were low. It was assumed that the difference in LDH activity and isozyme pattern is due to the differential presence of leukocytes in pleurisy i.e., granulocytes and lymphocytes in tubercle bacillus positive and negative pleurisy, respectively. In conclusion, tuberculous pleural effusions can be divided into two groups on the basis of ADA and LDH activities and isozymes which may reflect the presence of mycobacterium tuberculosis.     

AM、CYFRA21-1、NSE和CEA联合检测对恶性与结核性胸腔积液的鉴别诊断价值

用RIA检测了52例(男32例, 女20例)结核性胸腔积液组和74例(男49例,女25例)恶性胸腔积液组的肾上腺髓质素(AM)、CYFRA21-1、NSE和CEA水平,结果表明: 恶性胸腔积液组四项肿瘤标志物含量均显著高于结核性胸腔积液组, 四项联合检测可进一步提高诊断敏感性和准确性至90.5%和92.9%, 有显著性差异(P＜0.01).结论: 胸腔积液AM、 CYFRA21-1、NSE和CEA联合检测对鉴别恶性与结核性胸腔积液有实用价值, 可显著提高恶性胸腔积液的阳性诊断率.