降钙素原与腺苷脱氨酶联合检测诊断结核性胸腔积液

目的 探讨联合检测降钙素原(PCT)、腺苷脱氨酶(ADA)对结核性胸腔积液的诊断价值.方法 选择48例结核性胸腔积液患者(结核组)和28例恶性胸腔积液患者(恶性组),另外选择14例心衰引起的胸腔积液患者作为对照组.采用酶联免疫吸附法测定各组患者胸腔积液和血清中PCT、ADA水平.结果 结核组胸腔积液中PCT、ADA水平均明显高于恶性组和对照组(P＜0.05),结核组血清中PCT、ADA水平与恶性组和对照组差异均无统计学意义(P＞0.05).恶性组胸腔积液及血清中PCT、ADA水平与对照组差异均无统计学意义(P＞0.05).以胸腔积液PCT ＞0.325 ng/mL、ADA＞ 45 U/L为诊断界值,PCT、ADA诊断结核性胸腔积液的敏感性分别为79.2％、87.5％,特异性分别为83.3％、90.5％.两项指标串联诊断结核性胸腔积液的敏感性为75.0％,特异性为97.6％；两项指标并联诊断的敏感性、特异性分别为93.8％、81.0％.结论 联合检测胸腔积液中PCT和ADA水平,可以显著提高结核性胸腔积液诊断的敏感性和特异性,对防止误诊、漏诊有重要临床意义,而血清PCT、ADA水平对结核性胸腔积液诊断价值不大.

Combined detection of procalcitonin and adenosine deaminase for tuberculous pleural effusion

Objective To determine the diagnostic value of combined detection of procalcitonin(PCT) and adenosine deaminase(ADA) for tuberculous pleural effusion.Methods A total of 90 patients were classified into three groups depending on the cause of their effusion: tuberculous group(n=48),malignant group(n=28) and heart failure(control) group(n=14).The levels of PCT and ADA both in serum and pleural effusion were detected by enzyme-linked immunosorbant assay(ELISA).Results The levels of PCT and ADA in pleural effusion were significantly higher in tuberculous group than in malignant group and control group,but there were no significant differences in serum.PCT and ADA levels both in pleural effusion and serum had no significant differences between malignant group and control group.Using the PCT level(>0.325 ng/mL) and the ADA level(>45 U/L) in pleural effusion as critical values,the diagnostic sensitivities for PCT and ADA in tuberculous pleural effusion were 79.2% and 87.5%,and specificity were 83.3% and 90.5%.Furthermore,when the two indexes were concatenated,the diagnostic sensitivity for tuberculous pleural effusion was 75.0%,and specificity was 97.6%.While when they were paralleled,the sensitivity was 93.8%,and specificity was 81.0%.Conclusion Combined detection of PCT and ADA in pleural effusion can significantly increase the sensitivity and specificity for tuberculoous plueral effusion diagnosis,which has important clinical significance for preventing misdiagnosis and missed diagnosis.But determination of PCT and ADA in serum has no significant diagnostic value for tuberculous plueral effusion.