肺表面活性蛋白A 在渗出性胸腔积液中的临床应用

目的：评估肺表面活性蛋白A(surfactant protein-A，SP-A)在诊断渗出性胸腔积液(exudate pleural effusions，EPE)中的临床应用价值。方法：采用前瞻性研究，选取215例胸腔积液患者，分漏出性胸腔积液(transudate pleuraleffusions，TPE)和EPE两组，TPE组作为对照组。运用ELISA实验测定并比较胸腔积液中SP-A(pleural effusion SP-A，SP-Apl)和血清中SP-A(serum SP-A，SP-Ase)浓度。运用受试者工作特征(receiver operator characteristic，ROC)曲线及多变量Cox回归研究SP-A在诊断胸腔积液中的临床价值。结果：EPE组SP-Apl浓度明显高于TPE组[(189.8±43.4) ng/mL vs(22.3±5.1) ng/mL，P<0.01]；EPE组SP-Ase浓度明显高于TPE组[(78.9±11.3) ng/mL vs (25.8±12.4) ng/mL，P<0.05]；EPE组SP-Apl浓度明显高于SP-Ase浓度(P<0.01)。EPE组中肺腺癌患者SP-Apl浓度和SP-Ase浓度最高，且SP-Apl浓度明显高于SP-Ase浓度(P<0.01)。当SP-Apl浓度≥484.5 ng/mL时，诊断肺腺癌的敏感性为85.4%，特异性为95.2%，曲线下面积(area underthe curve，AUC)为0.943(95% CI：0.852~0.934，P<0.01)；当SP-Ase≥84.2 ng/mL时，诊断肺腺癌的敏感性为76.4%，特异性为94.3%，AUC为0.910(95% CI：0.921~0.953，P<0.01)。结论：SP-Apl浓度≥484.5 ng/mL和/或SP-Ase浓度≥84.2 ng/mL有助于诊断肺腺癌性胸腔积液。

Clinical value of surfactant protein-A in exudate pleural effusion

Objective: To evaluate the clinical value of surfactant protein-A (SP-A) in exudate pleural effusion (EPE).Methods: This clinical study was prospective, observational and cross-sectional. Two hundred and fifteen patients with pleural effusion were divided into the transudate pleural effusions (TPE) group and the EPE group. TPE patients served as the control group. The concentrations of pleural effusions SP-A (SP-Apl) and serum SP-A (SP-Ase) were measured by ELISA, and receiveroperator characteristic (ROC) curve and multivarate Cox analysis of SP-A was analysed for its clinical value. Results: SP-Apl concentrations in the EPE group were significantly higher than that in the TPE group [(189.8±43.4) ng/mL vs (22.3±5.1) ng/mL, P<0.01]; SP-Ase concentrations in the EPE groupwere higher than that in the TPE group [(78.9±11.3) ng/mL vs (25.8±12.4) ng/mL, P<0.05];SP-Apl concentrations were significantly higher than the concentrations of SP-Ase in the EPEgroup (P<0.01). In EPE group, SP-Apl and SP-Ase concentration in the patients with primarylung adenocarcinomas were the highest. The cut off value of SP-Apl concentrations was morethan 484.5 ng/mL, yielding a 85.4% sensitivity and 95.2% specificity for diagnosing primary lungadenocarcinomas, with an area under the curve (AUC) of 0.943 (95% CI 0.852 to 0.934, P<0.01);when SP-Ase concentration was more than 84.2 ng/mL, it yielded a 76.4% sensitivity and 94.3%specificity for diagnosing primary lung adenocarcinomas, with an AUC of 0.910 (95% CI 0.921 to0.953, P<0.01).Conclusion: While SP-Apl concentration is more than 484.5 ng/mL and/or SP-Ase concentrationis more than 84.2 ng/mL, it may be helpful for the diagnosis of primary lung adenocarcinomas withthe usage of pleural effusion.