ADA、ACE、LDH、CEA的联合检测在结核性和恶性胸腔积液中的鉴别诊断价值

目的测定血清和胸水中腺苷脱氨酶（ADA）、血管紧张素转化酶（ACE）、乳酸脱氢酶（LDH）与癌胚抗原（CEA）的水平,探讨其指标联合检测对结核性和恶性胸水的鉴别诊断意义。方法对临床已确诊的72例胸腔积液患者（结核性40例,恶性32例）的胸水和血清分别采用酶免疫法和化学发光法进行ADA、ACE、LDH和CEA含量测定。结果结核性胸水中ADA的含量为（60.2±20.10）U/L,ACE的含量为（35±9.6）U/L,LDH的含量为（338±41）U/L,CEA的含量为（12.8±5.82）μg/L;在恶性胸水中,ADA为（11.02±5.23）U/L,ACE为（16±11.0）U/L,LDH为（379±69.0）U/L,CEA为（39.9±19.7）μg/L。结核性胸水ADA和ACE含量较恶性胸水组明显增高（P〈0.01）,CEA在恶性胸水中含量较结核性胸水组明显增高（P〈0.01）。胸水中ADA和ACE的检测对结性性胸膜积液诊断的敏感性分别为84.3%、87.5%,特异性分别为87.5%、80.0%;而胸水中LDH和CEA的检测对恶性胸膜积液诊断的敏感分别为84.3%、75.0%,特异性分别为80.0%、93.0%。四项指标联合检测敏感性性为78.1%,特异性为97.5%,较单一指标的特异性高。结论胸水中ADA、ACE、LDH和CEA的联合检测对结核性和恶性胸水的鉴别诊断具有一定价值,有助于临床胸水性质的诊断。

Measuring ADA,ACE,LDH and CEA Jointly for Differential Diagnosis between Tuberculous and Malignant Pleural Effusion

Objective To determine the differential diagnosis value of adenosine dearninase （ADA）, Angiotensin converting enzymes （ACE）, Lactate dehydrogenase （LDH） and carcinoembryonic antigen （CEA） measured jointly between tuberculous and malignant pleural effusion. Method There were 72 objects that consisted of 32 patients with malignant pleural effusion（malignant group）, and 40 patients with tuberculous pleural effusion（tuberculous group）in the study. ADA, ACE, LDH were detected by terminal reaction of enzymology, while CEA was detected by chemiluninescence immunoassay. Result The ADA activity of tuberculous and malignant pleural effusion were （60.2±20.10）U/L and （11.02±5.23） U/L, respectively （P〈 0.01）. The ACE activity of tuberculous and malignant pleural effusion were （ 35 ± 9.6） U/L and （ 16 ± 11.0） U/L, respectively （P 〈 0.01 ）. The CEA activity of tuberculous and malignant exudate were （12.8±5.82） μg/L and （39.9±19.7） μg/L, respectively（P〈0.01）. The specific values of ADA and ACE（pleural effusion/serum）in tuberculous pleural effusion were significantly higher than that in malignant pleural effusion（P〈0.01）, so did it of the concentration. However, the specific values of CEA （pleural effusion/serum） in malignant pleural effusion were significantly higher than that in tuberculous pleural effusion（P〈0.01）, so did it of the concentration. Furthermore, the sensitivity of ADA and ACE for tuberculosis diagnosis was 84.3% and 87.5%, respectively, while the specificity was 87.5% and 80.0%. The sensitivity of the LDH, CEA for malignant diagnosis was 84.3% and 75.0%, respectively, while the specificity was 80.0% and 93.0%. Finally, the sensitivity of measuring all these targets jointly was 78.1%, and the specificity was 97.5%, which was higher than that of anyone in these targets significantly. Conclusion The detection of ADA, ACE, LDH and CEA jointly in pleural effusion is of great value in differentiating tuberculous pleural effusi