联合检测对结核性和恶性胸腔积液的鉴别诊断价值

目的探讨联合检测胸腔积液中腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)对结核性和恶性胸腔积液的诊断价值。方法以我院2012年1月至2012年12月112例住院的胸腔积液患者为研究对象,其中62例结核性胸腔积液患者,50例恶性胸腔积液患者,以酶比色法,免疫比浊法,速率法和电化学发光法检测上述患者胸腔积液中ADA、CRP、CEA和LDH浓度。结果结核性胸腔积液患者ADA和CRP的诊断敏感性显著高于恶性胸腔积液患者(P0.01),恶性胸腔积液患者CEA的诊断敏感性较结核性胸腔积液患者明显增高(P0.01)。以胸腔积液CEA7 ng/ml及LDH245 U/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为78.0%,80.6%;而以CEA7 ng/ml,LDH245 U/L及ADA40 U/L,CRP5 mg/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为94.0%,95.2%。以胸腔积液ADA40 U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为82.3%,86.0%;而以CEA7 ng/ml,LDH245 U/L及ADA4 0U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为96.8%,92.0%。结论联合检测胸腔积液中ADA、CRP、CEA、LDH的浓度可提高结核性和恶性胸腔积液鉴别诊断的敏感性和特异性。

Significance of combined detection of ADA,CRP, CEA and LDH in the differential diagnosis of tuberculous and malignant pleural effusion

Objective To investigate the clinical significance of combined detection of adenosine deaminase （ ADA） , C reactive protein （ CRP） , carcinoembryonic antigen （ CEA） and lactate dehydrogenase （ LDH） in pleural fluid in the differential diagnosis of tuberculous pleural effusion （ TPE ） and malignant pleural effusion （ MPE ） . Methods 112 patients with pleural effusion were selected, including 62 patients with tuberculous pleural effusion and 50 patients with malignant pleural effusion. The expressions of ADA, CRP, CEA and LDH were detected in the two groups by enzyme colorimetry, immune turbidimetry, rate method and electrochemiluminescence. Results The diagnosis sensitivity of ADA and CRP was significantly higher in patients with TPE than patients with MPE （ P 〈0. 01）, and the diagnosis sensitivity of CEA was significantly higher in patients with MPE than in patients with TPE （P〈0. 01）. Taking CEA〉7ng/ml and LDH〉245U/L in pleural effusion as standard, the diagnosis sensitivity of MPE was 78% and the specificity was 80. 6%. While taking CEA〈7ng/ml, LDH〉245U/L, ADA〈40U/L and CRP〈5mg/L as standard, the sensitivity of MPE increased to 94. 0% and the specificity 80. 6%. Taking ADA〈40U/L and CRP〈5mg/L as standard, the diagnosis sensitivity of TPE was 82. 3% and the specificity was 86. 0%, and it increased to 96. 8% and 92. 0% respectively while taking CEA〈7ng/ml, LDH〉245U/L, ADA〉40U/L and CRP〉5mg as standard. Conclusion The combined detection of ADA, CRP, CEA and LDH can significantly im-prove the sensitivity and specificity in the differential diagnosis of tuberculous and malignant pleural effusion.