结核性与恶性胸腔积液相关生化指标变化及鉴别诊断

目的]探讨结核性胸腔积液(TPE)与恶性胸腔积液(MPE)中相关生化指标变化及对鉴别诊断的意义.方法]选取2012年1月至2016年1月淄博市第一医院收治的胸腔积液患者92例,其中TPE患者52例(TPE组),MPE患者40例(MPE组).所有患者入院时均行胸腔穿刺术留取5 mL胸水,常规检测白细胞、淋巴细胞、中性粒细胞、嗜酸性粒细胞、间皮/组织细胞、总蛋白、乳酸脱氢酶、葡萄糖及细胞因子白细胞介素1β(IL-1β)、白细胞介素10(IL-10)、白细胞介素13(ID13)、r干扰素(IFN-γ)、趋化因子干扰素诱导蛋白10(IP-10)及碱性成纤维细胞生长因子(bFGF)].结果]TPE组患者胸水白细胞数目显著高于MPE组患者,其差异具有统计学意义(P＜0.05);但两组患者胸水中淋巴细胞、中性粒细胞、嗜酸性粒细胞、间皮/组织细胞、总蛋白、乳酸脱氢酶和葡萄糖水平比较差异均无统计学意义(P＞0.05).TPE组中IL-1β、IP-10、IL-13和IFN-γ水平显著高于MPE组(P＜0.05),MPE组中bFGF水平显著高于TPE组(P＜0.05);两组患者胸水IL-10水平比较差异无统计学意义(P＞0.05).ROC曲线分析结果显示,当最佳阈值分别为IL-1β 5.5 pg/mL、IP-10 4005 pg/mL、ID13 7.9 pg/mL、IFN-γ 100.5 pg/mL和bFGF 2.4 pg/mL时,对TPE与MPE具有鉴别诊断价值(P＜0.05).结论]IL 1β、IP-10、IL-13、IFN-γ和bFGF变化在TPE和MPE鉴别诊断中具有重要的价值.

Changes and Differential Diagnosis of Biochemical Markers related to Tuberculous and Malignant Pleural Effusion

Objective]To investigate the changes in biochemical markers between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) for their significance in making differential diagnosis.Methods]A total of 92 pleural effusion cases were collected from January 2012 to January 2016 at our hospital.Among them,there were 52 cases of TPE and 40 cases of MPE.At admission,5ml of pleural effusions was harvested by pleural biopsy.Routine examination of pleural effusion (white blood cells,lymphocytes,neutrophils,eosinophils,mesothelial/tissue cells,total protein,lactate dehydrogenase,glucose) and cytokines IL-1β,IL-10,IL13,IFN-gamma,chemokines interferon inducible protein 10 (IP-10),basic fibroblasts Cell growth factor (bFGF)]were tested.Results]The number of white blood cells in pleural effusion was significantly higher in TPE patients than in MPE patients (P ＜0.05).However,in MPE and TPE patients,the number of pleural effusion lymphocytes,neutrophils,eosinophils,mesothelial,Lactate dehydrogenase (LDH) and glucose were not statistically significant.The levels of IL-1β,IP-10,IL-13 and IFN-γin tuberculous pleural effusion were significantly higher than those in malignant pleural effusion.The level of bFGF in malignant pleural effusion was significantly higher than that in tuberculous pleural effusion.There were no significant differences in IL-10 levels in both pleural fluids.ROC curve analysis showed that when the optimal thresholds were 5.5 pg/mL for IL-1β,4005 pg/mL for IP-10,7.9 pg/mL for IL-13,100.5 pg/mL for IFN-γ and 2.4 pg/mL for bFGF (P ＜0.05),which was valuable in the diagnosis of tuberculous and malignant pleural effusion.Conclusion]The changes of IL-1β,IP-10,IL-13,IFN-γ and bFGF have important differential diagnostic value in tuberculous and malignant pleural effusion.