结核性与肿瘤性胸腔积液ADA、CEA、CA125、LDH水平分析

目的：检测结核性与肿瘤性胸腔积液中腺苷脱氨酶（ADA）、癌胚抗原（CEA）、糖链抗原125（CA125）、乳酸脱氢酶（LDH）水平，探讨其在鉴别诊断中的价值。方法选择2010年1月至2013年6月在该院住院的不明原因渗出性胸腔积液（胸腔积液生化、血常规、脱落细胞、细菌学、B超、肺CT等检查仍未确诊者）患者，经内科胸腔镜检查，确诊结核性胸腔积液组88例和肿瘤性胸腔积液组70例。术中同时抽取胸腔积液标本检测其ADA、CEA、CA125、LDH水平，进行统计学分析。结果结核性胸腔积液ADA水平显著高于肿瘤性胸腔积液，差异有统计学意义（t=21.490，P＜0.01）；肿瘤性胸腔积液CEA、CA125水平均显著高于结核性胸腔积液，差异均有统计学意义（t=41.300、18.400，P＜0.01）；结核性和肿瘤性胸腔积液LDH水平比较，差异无统计学意义（t=1.562，P＞0.05）。结论 ADA水平越高，结核可能性越大；CEA、CA125水平越高，肿瘤的可能性也更大；CEA、CA125水平均同时增高，肺癌可能性更大；LDH水平在结核与肿瘤性胸腔积液中差异不明显，所以联合检测ADA、CEA、CA125、LDH水平对胸腔积液性质的鉴别诊断具有重要的参考价值。

Analysis of the levels of ADA,CEA,CA125 and LDH in tuberculous and malignant pleural effusions

Objective To detect the levels of adenosine deaminase（ADA）,carcino-embryonic antigen（CEA）,carbohy-drate antigen（CA） 125 and lactic dehydrogenase（LDH） in tuberculous and malignant pleural effusions,and explore their value in diagnosis and differentiation. Methods A total of 158 patients with unexplained exudative pleural effusions ,who were exam-ined by biochemical tests of pleural effusion,blood routine,cast-off cells,pacteriology,type B ultrasound,lung CT and so on in the hospital from January 2010 to June 2013,were selected,and diagnosed with tuberculous pleural effusions（n=88） and malignant pleural effusions（n=70） by medical thoracoscopy. The pleural effusion was extracted during operation to determine the levels of A-DA,CEA,CA125 and LDH for statistical analysis. Results The ADA level of tuberculous pleural effusion was significantly high-er than that of malignant pleural effusions （t=21.490,P〈0.01）,The levels of CEA and CA125 of malignant pleural effusions were obviously higher than those of tuberculous pleural effusion with statistically significant difference （t=41.300,18.400;P〈0.01）. The difference on the LDH levels between tuberculous and malignant pleural effusions showed no significant difference （t=1.562, P〉0.05）. Conclusion The higher of the ADA level,the greater of the possibility of tuberculosis;the higher of the CEA and CA125 levels,the greater of the possibilities of tumor;when the CEA and CA125 are both increased,it is more likely to be lung can-cer;the difference of LDH level is not obvious in tuberculous and malignant pleural effusions,so the combined detection of ADA, CEA,CA125 and LDH has important clinical reference in differential diagnosis of the tuberculous and malignant pleural effusions.