应用ROC曲线评价结核抗体蛋白芯片法对老年结核性胸膜炎的诊断价值

目的探讨抗结核LAM、16k D和38k D抗体蛋白芯片法对结核性胸膜炎感染的诊断价值。方法回顾性分析2009年3月~2012年5月解放军309医院收治的49例结核性胸膜炎及77例恶性胸腔积液的老年患者临床资料,采用结核分枝杆菌Ig G抗体检测试剂盒(蛋白芯片)检测其抗结核LAM、16k D和38k D抗体,构建单独或3种结核抗体联合应用诊断结核性胸膜炎的ROC曲线,并与胸水涂片抗酸染色试验进行相关比较。结果 LAM、16k D、38k D、联合检测和抗酸染色的敏感性分别为69.39%、24.49%、69.39%、69.39%和22.45%,特异性分别为92.21%、100.00%、100.00%、100.00%和97.40%,诊断准确性分别为83.33%、70.63%、88.10%、88.10%和68.25%。ROC曲线下面积(AUC)分别为0.81、0.62、0.85、0.85和0.60,联合检测结核抗体的诊断效能显著高于胸水涂片抗酸染色试验(P0.05)。结论联合检测LAM、16k D及38k D结核抗体诊断结核性胸膜炎准确、便捷,有较高的实用价值。

Combined detection of 3 antibodies against mycobacterium tuberculosis:evaluation of the diagnosis of senile tuberculous pleurisy using ROC curves

Objective To detect 3 antibodies against tuberculoprotein, LAM, and 2 proteins at molecular weights of 38kD and 16kD using a protein chip and to explore its clinical value in the diagnosis of senile tuberculous pleurisy. Methods The serum antibodies(LAM,16kD and 38kD)from 126 senile patients(49 cases of tuberculous pleurisy and 77 cases of malignant pleural fluid) were analyzed using a protein chip, and the corresponding receiver operating characteristic (ROC) curves for single and combined multi-antibodies were also constructed in order to evaluate their diagnostic values for tuberculous pleurisy, which is compared with acid fast stain of pleural fluid. Results The 16kD, LAM, 38kD and, especially, the combined test, showed better diagnostic effects over acid fast stains of pleural fluid with superior sensitivity(69.39%,69.39%,69.39% over 22.45%),specificity(92.21%,100.00%, 100.00% over 97.40%),accuracy (83.33%,88.10%,88.10% over 68.25%)and area under curve (AUC)results (0.81,0.85,0.85 over 0.60)(P < 0.05). Conclusion The tuberculosis protein chip assay of LAM,16kD and 38kD is a more convenient and rapid test for the diagnosis of tuberculous pleurisy that could significantly improve the diagnostic effect.