胸液蛋白电泳及腺苷脱氨酶在结核性与恶性胸腔积液鉴别诊断中的应用

目的对结核性及恶性胸腔积液患者的胸液蛋白电泳进行分析及ADA检测,探讨二者在结核性胸腔积液与恶性胸腔积液诊断中的应用价值。方法对36例结核性胸腔积液患者及38例恶性胸腔积液患者的胸液标本行琼脂糖凝胶蛋白电泳并应用比色法检测腺苷脱氨酶(ADA)浓度。结果结核性胸腔积液组与恶性胸腔积液组的胸液α₁球蛋白分别为4.32±1.35和3.41±0.97(P＜0.05),α₂球蛋白分别为8.98±1.50和6.01±1.53(P＜0.000),α₂球蛋白/白蛋白的比值分别为0.15±0.03和0.09±0.03(P＜0.000),ADA分别为71.35±24.00和31.21±11.90(P＜0.000)。根据ROC曲线结果判断分别取0.13及45为界值,计算α₂球蛋白/白蛋白对诊断结核性胸腔积液的敏感性、特异性及准确性分别为76%、89%、83%;ADA的敏感性、特异性及准确性分别为82%、78%、80%。采用平行试验方法,联合α₂球蛋白/白蛋白和ADA指标,其敏感性、特异性和准确性分别达到88%,100%和94%。结论(1)结核性胸腔积液患者的胸液α₁球蛋白、α₂球蛋白、α₂球蛋白/白蛋白的比值及ADA均高于肿瘤组,差异有显著性(P＜0.05)。(2)联合检测α₂球蛋白/白蛋白和ADA可以提高结核性胸腔积液诊断的敏感性、特异性和准确性。

The diagnosis value of protein electrophoresis and adenosine deaminase in tuberculosis and malignant pleural effusion

Objective To study the diagnostic value of pleural effusions protein electrophoresis and Adenosine Deaminase(ADA) in differentiating tuberculosis from malignant pleural effusion.Methods Thirty-six patients with tuberculous pleuritis and thirty-eight patients with malignant pleural effusion were examined.Protein electrophoresis and ADA of pleural fluid were measured by SEBIA HYDRASYS and colorimetry respectively.Results In tuberculosis and malignant pleural effusion,the level of α₁ global protein were4.32±1.35 and 3.41±0.97(P＜0.05),α₂ global protein were 8.98±1.50 and 6.01±1.53(P＜0.000),the ratio of α₂ global protein and album were 0.15±0.03 and 0.09±0.03(P＜0.000),and ADA were 71.35±24.00 and 31.21±11.90(P＜0.000).According to receiver operating characteristic curve(ROC),the sensitivity,specificity and accuracy of the ratio of α₂ global protein and album for diagnosing tuberculosis pleural effusion were 76%,89%,and 83% respectively.And the sensitivity,specificity and accuracy of ADA were 82%,78% and 80% respectively.The sensitivity,specificity and accuracy were 88%,100% and 94% when the two Methods were combined.Conclusion (1) The levels of α₁ global protein,α₂ global protein,the ratio of α₂ global protein and album,and ADA in tuberculosis pleural effusion were higher than that in malignant pleural effusion(P＜0.05).(2) Combining the ratio of α₂ global protein and album with ADA can raise the sensitivity,specificity and accuracy for diagnosing tuberculosis pleural effusion.