外周血T-SPOT.TB和胸腔积液中ADA、LDH对结核性胸膜炎的诊断价值

目的 探讨腺苷脱氨酶（adenosine deaminase，ADA）、乳酸脱氢酶（lactate dehydrogenase，LDH）水平以及外周血结核感染T淋巴细胞酶联免疫斑点试验（T-SPOT.TB）对结核性胸膜炎的诊断价值。
方法 回顾性分析40例结核性胸膜炎患者和48例非结核性胸膜炎患者的外周血T-SPOT.TB检测值和胸腔积液的ADA、LDH水平，分析三者的受试者工作特征曲线（receiver operating characteristic curve，ROC）。
结果 非结核性胸膜炎组患者ADA、LDH、TSPOT.TB和三项联合检测所得阳性率均远低于结核性胸膜炎组患者，差异有统计学意义（P < 0.01）；结核性胸膜炎组患者中，三项联合检测的阳性率最高，达95.0%。非结核性胸膜炎组四类检测方法所得阳性率差异有统计学意义（P < 0.01），其中三项联合检测所得阳性率仅有2.08%（1例）。结核性胸膜炎组胸腔积液中LDH水平、ADA水平中位数均高于非结核性胸膜炎组，差异有统计学意义（P < 0.01）；ADA和T-SPOT.TB对应的ROC曲线下面积等大，且大于LDH对应面积；T-SPOT.TB的ROC曲线最靠近左上角；诊断结核性胸腔积液特异度依次为:T-SPOT.TB > ADA > LDH，灵敏度依次为:ADA > T-SPOT.TB > LDH。
结论 TSPOT.TB、ADA和LDH检测对结核性胸膜炎的快速诊断具有重要的临床价值，又以T-SPOT.TB诊断效能最优。

Diagnostic efficiency of ADA and LDH in pleural effusion and T-SPOT.TB in peripheral blood for tuberculous pleurisy

Objective To investigate the efficiency of peripheral blood tuberculosis infection T cell spot test (T-SPOT.TB), adenosine deaminase (ADA)and lactate dehydrogenase (LDH) activity of pleural effusion for tuberculous pleurisy. Methods The receiver operating characteristic (ROC) curve was used to analyze the examination results of ADA and LDH of pleural effusion and T-SPOT.TB in peripheral blood in both 40 patients with tuberculous pleurisy and 48 patients with non-tuberculous pleurisy. Results The positive rates of ADA, LDH, TSPOT.TB and three combined tests in patients with non-tuberculous pleurisy were significantly lower than those of patients with tuberculous pleurisy (P < 0.01). Among patients with tuberculous pleurisy, the positive rate of combined three indicators was the highest (95.0%). The positive rates of these indicators among patients with non-tuberculous pleurisy varied statistically (P < 0.01), and only 1 patient (2.0%) had positive rate for all combined 3 indicators. The medians of LDH and ADA levels in pleural effusion of patients with tuberculous pleurisy were higher than those in the patients with non-tuberculous pleurisy(P < 0.01). The area of ADA under the ROC curve was equal to that of T-SPOT.TB, and was larger than that of LDH; the ROC curve of T-SPOT.TB was the closest to the top left. For diagnosis of tuberculous pleural effusion, the order of specificity was T-SPOT. TB > ADA > LDH, and the order of sensitivity was ADA > TSPOT.TB > LDH. Conclusion T-SPOT.TB, ADA and LDH test had important clinical value in the rapid diagnosis of tuberculous pleurisy, and the clinical value of T-SPOT.TB was the best.