胸腔镜与蛋白指纹图谱技术在胸腔积液诊断中的应用

目的 探讨胸腔镜与蛋白指纹图谱检测技术（PFT），在恶性和结核性胸腔积液早期诊断中的作用。 方法 2009年1月至2010年12月福建省福州肺科医院住院经影像学检查发现有胸腔积液，经内科胸腔镜检查、病理学（或细菌学）、胸腔积液蛋白指纹图谱检测临床确诊的121例住院患者，选择无其他并存病，经胸腔镜检测病理确诊的恶性胸腔积液患者30例（Ⅰ组）和结核性胸腔积液患者50例（Ⅱ组），同时进行胸腔积液蛋白指纹图谱检测，分析其相关蛋白峰值并进行统计学处理。 结果 Ⅰ组和Ⅱ组行蛋白指纹图谱检测，两组间有7个差异蛋白峰（分别为5335、8048、11 700、11 670、15 982、11 683、7700 m/z），依据蛋白峰值表达情况，以11 670、11 700 m/z的蛋白峰用于建立恶性胸腔积液诊断模型，诊断Ⅰ组阳性率达83.3%（25/30），Ⅱ组为24.0%(12/50)，两组差异有显著统计学意义（χ²=26.55，P<0.01），倾向于判定恶性胸腔积液；其敏感度为83.3%（25/30），特异度为76.0%（38/50）；以5335、8048 m/z用于建立结核性胸腔积液诊断模型，2种蛋白峰建立Ⅰ组与Ⅱ组的鉴别诊断模型结果，诊断Ⅰ组阳性率达16.7%（5/30），Ⅱ组为52.0%(26/50)，两组差异有显著统计学意义（χ²=9.86，P<0.01），倾向于判定结核性胸深积液；其敏感度为52.0%（26/50），特异度为83.3%（25/30）。 结论 胸液蛋白指纹图谱检测技术简便、快速，是鉴别结核性与恶性胸腔积液特异性标志物的有效手段，但尚需在判读方法上做进一步深入研究。

The application of thoracoscopy and proteomic fingerprinting technique in the diagnosis of pleural effusion

Objective To study the clinical value of thoracoscopy and protein fingerprinting technique（PFT）in improving the early diagnosis of cancer and tuberculous pleural effusions. Methods Of 121 cases with pleural effusions confirmed by imaging examination, thoracoscopy, pathological or bacteriological examination, 30 cases with malignant pleural effusion and 50 cases with tuberculous pleural effusion were detected simultaneously pleural fluid protein fingerprint peaks, and the data were statistically analyzed. Results There were 7 different protein peaks between two groups（m/z 5335, 8048, 11 700, 11 670, 15 982, 11 683 and 7700）. The protein peaks m/z 11 670 and m/z 11 700 were selected to establish the diagnosis model of malignant effusion, which was statistically significant between two groups (χ²=26.55, P<0.01). Its sensitivity and specificity for the malignant effusion were 83.3%（25/30）and 76.0%（38/50）, respectively. The protein peaks m/z 5335 and m/z 8048 were used to establish the diagnosis model of tuberculous pleural effusion, which was significantly different between two groups (χ²=9.86, P<0.01). The sensitivity and specificity for the tuberculous effusion were 52.0%（26/50）and 83.3%（25/30）, respectively. Conclusion The pleural fluid protein fingerprint technique is a simple, fast and effective means for the differential diagnosis of tuberculous and malignant effusions, but need be further studied in the interpretation of protein maps.