结核性胸膜炎患者胸水中MMP-9和TIMP-1水平的临床意义

目的：探讨基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶组织抑制物-1（TIMP-1）及MMP-9/TIMP-1比值在结核性胸膜炎致胸腔积液的形成过程中的作用及鉴别诊断中的价值。方法：采用ELISA法测定36例结核性胸膜炎、30例非结核性胸膜炎患者胸水中的MMP-9和TIMP-1浓度。结果：（1）结核性胸腔积液组胸水中MMP-9浓度、TIMP-1浓度和MMP-9/TIMP-1比值均显著高于非结核性胸腔积液组（83.76±47.36ng.mL^-1比38.83±16.53ng.mL^-1,600.17±121.46ng.mL^-1比481.67±96.36ng.mL^-1,0.147±0.097比0.081±0.018,P〈0.001）。（2）胸水中MMP-9、TIMP-1、MMP-9/TIMP-1比值在结核性胸腔积液诊断中的敏感性分别为88.9%、72.2%和80.6%,特异性分别为65.4%、63.5%和75.0%。采用胸水MMP-9和TIMP-1串联联合检测的敏感性和特异性分别为33.3%和94.2%,并联联合检测的敏感性和特异性分别为83.3%和53.8%。结论：MMP-9、TIMP-1及MMP-9/TIMP-1比例的失衡与结核性胸膜炎胸腔积液的形成密切相关,它们在结核性胸膜炎所致胸腔积液的诊断中有一定参考价值。

The Clinical Value of Matrix Metalloproteinase and Tissue Inhibitor of Metalloproteinase in Diagnosis of Tuberculous Pleural Effusion

Objective：The aim of this study was to explore the role of matrix metalloproteinase-9 （MMP 9）, tissue inhibitor of metalloproteinase-1 （TIMP-1） and the value of MMP-9/TIMP-1 ratio in the pathogenesis and diagnosis of pleural effusion in tuberculous pleuritis. Methods： MMP 9 and TIMP-1 in the pleural fluid were detected by enzyme-linked immunosorbent assay （ELISA） in 66 patients with and without tuberculous pleuritis （of which 36 cases with tuberculous pleuritis）. Results： 1. The value of MMP-9,TIMP-1 and the MMP 9/TIMP-1 ratio were higher in tuberculous pleural effusion than in the other group （83.76±47.36 ng· mL^-1 vs. 38.83±16.53 ng· mL^-1, 600.17 ±121. 46 ng· mL^-1 vs. 481.67±96.36 ng· mL^-1,0. 147± 0.097 vs. 0.081 ± 0. 018,P〈0.01 ）. 2. In diagnosing tuberculous pleutitis, the sensitivity of MMP-9, MMP -1 and MMP-9/ MMP-1 ratio are respectively 88.9% ,72.2% and 80.6%, the specificity are 65.4% ,63.5% and 75.0% ; however, in the diagnosing process, the sensitivity and specificity are 33. 3% and 94. 2% if we combine MMP-9 and MMP-1 in a series way, 83.3 % and 53.8 % in a parallel way. Conclusion： MMP-9,TIMP-1 and MMP-9/TIMP -1 ratio were closely related to the pleural effusion in tuberculous pleuritis, Patients of pleural effusion which is caused by tuberculous pleurisy exhibit regional MMP -9/ TIMP-1 imbalance of pleural cavity. Detection of MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio of pleural effusion contributes to the diagnosis of tuberculous pleural effusion.