超敏C-反应蛋白和腺苷脱氨酶联合检测鉴别结核性胸膜炎和肿瘤胸腔积液

目的探讨超敏C-反应蛋白（hs-CRP）和腺苷脱氨酶（ADA）联合检测鉴别结核性胸膜炎和肿瘤胸腔积液的价值。方法对2007年武汉市结核病防治所住院收治的116例胸腔积液患者,患者分为结核组和肿瘤组，分别检测hs-CRP、ADA，并纳入受试者工作曲线,以最高敏感性和特异性决定截断点。结果结核组hs-CRP、ADA中位数为(56.76±16.62) mg/L和(47.89±12.97) IU/L,肿瘤组为(22.72±5.04) mg/L和(21.61±5.97) IU/L。结核组hs-CRP、ADA的敏感性和特异性分别为98.6%、97.6%和95.9%、95.2%,曲线下面积(AUC)分别为0.999(0.998-1.001,95%CI)、0.993(0.982-1.003,95%CI)。hs-CRP联合ADA的敏感性和特异性分别为90.5%、98.7%。结论hs-CRP和ADA对结核渗出性胸膜炎和肿瘤胸腔积液的鉴别都有很重要的参考价值，CRP优于ADA，联合检测意义更大。

The value of high-sensitive C-reactive protein (hs-CRP) and adnosine deaminase(ADA) in the diagnosis of tuberculous pleuritis

Objective To study the value of high-sensitive C-reactive protein （hs-CRP） and adnosine deaminase（ADA） in the diagnosis of tuberculous pleuritis. Methods We studied 116 consecutiye cases with pleural fluid admitted in 2007. The patients with pleural fluid were divided into two groups, tuberculosis（TB） ,non-TB. The hs-CRP and ADA were detected, respectively, and included in receiver operating characteristic curve, which was used to determine cutoff values with the highest sensitivity and specificity. Results The level of hs-CRP and ADA in the TB group were （56.76± 16.62） mg/L and （47.89± 12.97）IU/L, respectively, they in non-TB group were （22.72±5.04） mg/L and （21.61±5.97） IU/L, respectively. The sensitivity and specificity of hs- CRP and ADA in the TB group were 98.6%, 97.6% and 95.9%, 95.2%, respectively. The area under the curve both hs-CRP and ADA was 0. 999（0. 998--1. 001,95%CI）, 0. 993（0. 982--1. 003, 95%CI）, respectively. The sensitivity and specificity of the detection combined hs-CRP with ADA were 90.5% and 98.7%, respectively. Conclusion The detection of hs-CRP and ADA in pleural fluid have important value for the diagnosis of tuberculous pleuritis.