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.     

ADA、TB-Ab-IgG检测对结核性胸膜炎诊断及鉴别诊断的临床价值

目的探讨胸水和血清腺苷脱氨酶（ADA）、结核抗体（TB—Ab—IgG）检测对结核性胸膜炎的诊断价值。方法采用斑点金免疫渗滤试验（DIGFA）和酶连续监测法对117例患者进行胸水和血清TB_Ab．IgG和ADA检测分析。结果87例结核性胸膜炎患者胸水、血清中TB-Ab-IgG的敏感性分别为62．0％和70．1％,特异性分别为93．1％和86．6％。ADA活性在结核性和癌性胸水中分别为52．51和10．26U／L（P〈0．01）。以胸水ADA≥40U／L做为诊断结核的临界值,其敏感性为79．3％,特异性为86．6％;以胸水ADA／血清ADA〉1．00为临界值,其敏感性为97．7％,特异性为96．6％。结论胸水和血清ADA、TB—Ab—IgG检测对结核性胸膜炎和非结核性胸膜炎具有诊断和鉴别诊断价值。     

Role of biochemical tests in the diagnosis of exudative pleural effusions

OBJECTIVES: To examine the diagnostic utility of pleural adenosine deaminase (PADA), pleural lactate dehydrogenase (PLDH), and several other biochemical tests in bronchogenic carcinoma and malignant mesothelioma, and to compare biochemical characteristics of their fluid with nonmalignant pleural effusions. DESIGN AND METHODS: This study consisted of 226 patients diagnosed with malignant (75), tuberculous (65), and parapneumonic pleural effusions (86). We examined the following biochemical parameters in the pleural fluid and serum: adenosine deaminase, lactate dehydrogenase, glucose level, protein level, pleural fluid/serum ADA ratio (P/S ADA), P/S LDH ratio, and P/S protein ratio. RESULTS: Parapneumonic pleural effusions had a significantly higher level of PLDH and of P/S LDH than malignant and tuberculous pleural effusions (P = 0.000), and malignant pleural effusions had a higher level of PLDH than tuberculous pleural effusions. Tuberculous and parapneumonic effusions had significantly higher levels of PADA than those of malignant effusions (P = 0.000). When the 54 patients having bronchogenic carcinoma were compared to the remaining 21 mesothelioma patients, the former had a lower median level of PADA (P = 0.001) with a higher level of PLDH (P = 0.05). CONCLUSION: Our results show that high pleural LDH and low PADA levels are suggestive of pleural effusion due to bronchogenic carcinoma, whereas high levels of PADA alone can be indicative of tuberculous pleural effusion and high levels of both markers can show complicated parapneumonic effusions or empyema.     

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。     

ROC曲线评价腺苷脱氨酶在结核性、恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶（ADA）测定在结核性胸腔积液及恶性胸腔积液患者的鉴别诊断价值。方法应用受试者工作曲线（ROC）对176例结核性胸腔积液患者及162例恶性胸腔积液患者的胸腔积液ADA、血清ADA、胸腔积液ADA/血清ADA检测结果进行分析评价。结果 （1）血清ADA在两组资料间差异无统计学意义（P〉0.05）,胸腔积液ADA、胸腔积液ADA/血清ADA在两组资料间比较差异均有统计学意义（P〈0.05）,二者的敏感性分别为92.9%、71.9%,特异性分别为94.7%、100%,准确度分别为93.4%、78.6%。（2）胸腔积液ADA、胸腔积液ADA/血清ADA在ROC曲线下面积分别为0.942、0.909。胸腔积液ADA、胸腔积液ADA/血清ADA对结核性胸腔积液的临床诊断临界点分别为16.4U/L、2.57。结论胸腔积液ADA在结核性和恶性胸腔积液的鉴别中具有重要的临床价值,可作为结核性胸腔积液的生物标志物。     

Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy

BACKGROUND: Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and insufficient efficiency of traditional diagnostic methods. We investigated the use of adenosine deaminase (ADA) activity in tuberculous pleuritis diagnosis. METHODS: We optimized a kinetic assay and retrospectively analysed 210 patients with exudative pleural effusions. Using the ROC curve, we determined the optimal cutoff for TB pleurisy. RESULTS: One hundred forty-seven exudative samples were nontuberculous (non-TB) and 63 were tuberculous (TB). There was statistically significant difference (p<0.0001) between the means of pleural fluid ADA levels among the TB and non-TB populations. The disease prevalence of TB pleurisy in the studied population was 30%. The cutoff value for diagnosing TB effusions was >55.8 U/L, with a sensitivity of 87.3% (95% CI: 76.5-94.3%) and specificity of 91.8% (95% CI: 86.2-95.7%). The positive predictive value (PPV) was 82.1% and the negative predictive value (NPV) was 94.4%. A pleural fluid ADA value <16.81 IU/L suggests that a tuberculous effusion is highly unlikely (100% sensitive with 100% NPV and 0% negative likelihood ratio for a pleural fluid ADA level>/=16.81 U/L). In addition, the area under the ROC curve was 0.933 (S.E.=0.0230, 95% CI: 0.890-0.963). CONCLUSION: Pleural fluid total ADA assay is a sensitive and specific test suitable for rapid diagnosis of TB pleurisy.     

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.     

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.     

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。     

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...     

循证检验医学原则指导多项检测在鉴别胸腔积液性能上的应用

目的 探讨循证检验医学原则指导下对多项检测在胸腔积液性能鉴别的临床应用价值。 方法 应用化学发光免疫分析法、光学比色法、固相酶免疫法、皮试法、血沉按国际标准法分别对已确诊的肺癌、肺结核、肺部感染胸腔积液100例患者的血清及胸腔积液同时进行癌胚抗原,糖类抗原199,鳞癌相关抗原、可溶性细胞角质蛋白片断19和神经原特异烯醇化酶、腺苷脱氨酶及乳酸脱氢酶、结核菌素试验、结核抗体免疫球蛋白G、红细胞沉降率等10项检测。 结果肿瘤标志物及LDH:肺癌组明显高于结核组和感染组,胸腔积液两者有显著差异(P＜0.05);ADA:结核组阳性率达92%,肺癌组及感染组则正常;PPD:结核组阳性率为62%,感染组为50%,肺癌组为19.2%;TBAb-IgG:结核组仅为4%,而肺癌组和感染组均为阴性;ESR增高率:结核组为94%,肺癌组为84.6%,感染组为83.3%。结论在循证检验医学原则指导下,用诊断性试验的特征值对癌性、结核性、炎症性胸腔积液性质鉴别作客观评价,为临床医生选择试验项目提供依据。实验证明胸腔积液检测肿瘤标志物水平和酶活性的灵敏度、特异性均明显高于血清,用于鉴别3种积液性质更有价值。      

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.     

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。     

Pleural fluid and serum procalcitonin as diagnostic tools in tuberculous pleurisy

BACKGROUND: Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and decreased efficiency of traditional diagnostic methods. We investigated the use of procalcitonin (PCT) concentration in tuberculous pleuritis diagnosis. METHODS: A prospective clinical study was performed with two different patient groups. A total of 28 patients were included: 18 with tuberculosis and 10 with nontuberculous pleurisy. Serum and pleural fluid PCT concentrations were evaluated before treatment. RESULTS: Serum and pleural fluid PCT concentrations were statistically different between tuberculous and nontuberculous pleurisy groups (P = 0.012 and P = 0.004, respectively), even though they were not elevated in relation to the cut-off level of 0.5 ng/mL. A positive and significant correlation was detected between serum and pleural fluid PCT levels (r = 0.49, P = 0.008). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating tuberculous from nontuberculous pleurisy were 80% and 72.2%, and 90% and 66.7% at the 0.081 and 0.113 ng/mL cut-off values, respectively. CONCLUSION: Relative to the current cut-off level of 0.5 ng/mL, PCT concentration is not a useful parameter for the diagnosis of tuberculous pleurisy. Because there were PCT levels in patients with tuberculous pleurisy that were below the current cut-off level but were significantly different from those of the nontuberculous group, the use of PCT should be further investigated.     

结核杆菌γ-干扰素体外释放试验对结核性胸腔积液的诊断价值

目的探讨体外释放酶联免疫法检测结核杆菌γ-干扰素(TB-IGRA)对结核性胸腔积液的诊断价值。 方法收集济宁医学院附属医院呼吸科2014年1～9月诊治的55例结核性和49例恶性胸腔积液患者的病例资料,对患者进行TB-IGRA、细菌涂片镜检、结核菌素皮试(PPD)和结核杆菌抗体等检测,并对以上诊断方法进行比较分析。同时联合检测血清癌胚抗原(CEA)及胸腔积液腺苷脱氨酶(ADA),以评估TB-IGRA联合CEA和ADA对鉴别诊断结核性胸腔积液的意义。采用SPSS 17.0统计软件进行数据分析,阳性例数以率表示,并进行卡方检验。CEA和ADA的测定值用均数±标准差表示,显著性检验用t检验。 结果55例结核组患者TB-IGRA阳性53例,达96.36%;49例恶性组患者TB-IGRA阳性1例,仅2.04%,两组差异有统计学意义(χ²＝88.62,P<0.05)。结核组血清CEA水平[(2.34±1.80)μg/L]显著低于恶性组[(2 358.68±1 069.40)μg/L,t＝－15.42,P<0.05];胸腔积液ADA水平[(57.51±26.90)U/L]显著高于恶性组[(14.43±3.57)U/L,t＝11.76 ,P<0.05]。结核组中TB-IGRA、涂片镜检、PPD试验以及结核杆菌抗体的阳性率分别为96.36%、22.64%、46.67%和35.14%,TB-IGRA的阳性检测率最高(χ²＝78.60,P<0.05);TB-IGRA对诊断结核性胸腔积液的敏感度(95.65%)、特异度(96.77%)、阳性预测值(97.78%)、阴性预测值(93.75%)及准确性(92.42%)最高。 结论与传统的检测指标相比,TB-IGRA更具灵敏性和特异性;TB-IGRA联合CEA、ADA检测对诊断结核性胸腔积液具有极为重要的临床价值。     

Monocytes subtypes from pleural effusion reveal biomarker candidates for the diagnosis of tuberculosis and malignancy

BackgroundPleural effusion is a common clinical condition caused by several respiratory diseases, including tuberculosis and malignancy. However, rapid and accurate diagnoses of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remain challenging. Although monocytes have been confirmed as an important immune cell in tuberculosis and malignancy, little is known about the role of monocytes subpopulations in the diagnosis of pleural effusion.MethodsPleural effusion samples and peripheral blood samples were collected from 40 TPE patients, 40 MPE patients, and 24 transudate pleural effusion patients, respectively. Chemokines (CCL2, CCL7, and CX3CL1) and cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were measured by ELISA. The monocytes phenotypes were analyzed by flow cytometry. The chemokines receptors (CCR2 and CX3CR1) and cytokines above in different monocytes subsets were analyzed by real‐time PCR. Receiver operating characteristic curve analysis was performed for displaying differentiating power of intermediate and nonclassical subsets between tuberculous and malignant pleural effusions.ResultsCCL7 and CX3CL1 levels in TPE were significantly elevated in TPE compared with MPE and transudate pleural effusion. Cytokines, such as IL‐1β, IL‐17, IL‐27, and IFN‐γ, in TPE were much higher than in other pleural effusions. Moreover, CD14⁺CD16⁺⁺ nonclassical subset frequency in TPE was remarkably higher than that in MPE, while CD14⁺⁺CD16⁺ intermediate subset proportion in MPE was found elevated. Furthermore, CX3CL1‐CX3CR1 axis‐mediated infiltration of nonclassical monocytes in TPE was related to CX3CL1 and IFN‐γ expression in TPE. Higher expression of cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were found in nonclassical monocytes compared with other subsets. Additionally, the proportions of intermediate and nonclassical monocytes in pleural effusion have the power in discriminating tuberculosis from malignant pleural effusion.ConclusionsCD14 and CD16 markers on monocytes could be potentially used as novel diagnostic markers for diagnosing TPE and MPE.     

不同类型标本腺苷脱氨酶对结核病诊断界点确定

目的探讨血清、胸腹腔积液、脑脊液中腺苷脱氨酶(ADA)测定对结核性胸腹腔积液、结核性脑膜炎诊断及鉴别诊断的临床应用价值。并通过ROC曲线分别确定胸腹腔积液、脑脊液中ADA测定对结核具有最佳诊断价值的界点。方法测定实验组与对照组血清、胸腹腔积液、脑脊液中的ADA。结果胸腹腔积液、脑脊液、血清中ADA对结核病诊断的阳性率分别达到了94.1%,60%,71.2%,30%,明显高于两种传统方法(P<0.01)。通过ROC曲线确定出胸腹腔积液、脑脊液ADA测定对结核病具有最佳诊断价值的界点分别为20和14U/L。结论血清、胸腹腔积液、脑脊液中ADA测定对结核病具有较高临床应用价值,但不同标本类型具有不同诊断界点。     

Pleural fluid neopterin levels in tuberculous pleurisy

OBJECTIVES: Neopterin is produced by stimulated macrophages under the influence of gamma interferon of lymphocyte origin. It is regarded as a biochemical marker of cell-mediated immune response. This study was designed to assess the diagnostic value of pleural fluid neopterin levels in tuberculous pleurisy in comparison with adenosine deaminase activity. DESIGN AND METHODS: Pleural fluid adenosine deaminase (ADA) activity and neopterin levels were measured in 16 patients with tuberculous pleurisy (TP) and 19 patients with malignant pleurisy (MP). ADA activity was determined by a colorimetric method, whereas neopterin levels were determined by a reversed-phase liquid chromatography technique. All values were given as median (min-max). RESULTS: The mean age was 45.43+/-20.39 years in the TP group and 60.42+/-11.02 years in the MP group (p=0.026). The median pleural fluid ADA activity was 51.75 U/L (3.50-62.40 U/L) in the TP group and was 2.30 U/L (1-8.20 U/L) in the MP group. The difference was statistically significant (p<0.001). The median pleural fluid neopterin levels were 13.15 nmol/L (1.86-59.50 nmol/L) and 2.44 nmol/L (0.92-27.60 nmol/L) in the TP group and the MP group, respectively (p=0.021). In order to evaluate the diagnostic value of pleural fluid neopterin concentrations, receiver-operating-characteristic curve analysis was performed. CONCLUSION: Pleural fluid neopterin concentration is significantly higher in TP when compared to MP, however when compared, its clinical use as a diagnostic marker is not valuable as ADA.     

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。     

腺苷脱氨酶在结核性胸腔积液中的诊断价值

目的探讨腺苷脱氨酶(ADA)活性测定在结核性胸腔积液诊断中的应用价值。方法对100例胸腔积液患者胸腔积液中ADA活性进行检测,并对其中的60例结核性胸腔积液和40例非结核性胸腔积液进行ADA活性比较。结果 100例患者胸腔积液中ADA活性增高共62例,其中结核组58例,非结核组4例,结核性胸腔积液组ADA活性为(54.21±15.24)U/L,明显高于恶性胸腔积液组〔(18.76±9.35)U/L〕及炎性胸腔积液组〔(16.58±8.24)U/L〕,差异有统计学意义(P<0.01);ADA诊断结核性胸腔积液的灵敏度为96.7%(58/60)、特异度为90%(36/40)。结论胸腔积液ADA活性检测可以作为鉴别结核性与非结核性胸腔积液的指标。