结核性与癌性胸腔积液的鉴别诊断

发布时间：2018-03-07 00:16

本文选题：结核性胸腔积液　切入点：癌性胸腔积液　出处：《中华医院感染学杂志》2014年19期 　论文类型：期刊论文

【摘要】：目的建立基于γ干扰素释放试验(IGRA)、C-反应蛋白(CRP)、腺苷脱氨酶(ADA)、肿瘤标记物及感染相关细胞因子等鉴别手段的联合检测体系,提高临床对于结核性与癌性胸膜炎的诊断能力。方法选择2011年3月-2012年9月诊断明确、资料完整的胸腔积液患者86例,将其分为结核性胸腔积液组59例、癌性胸腔积液组27例,均常规进行IGRA检测,同时综合评估并筛选ADA、CRP、白介素-2、4、6、10(IL-2、4、6、10)、干扰素γ(IFN-γ)、肿瘤坏死因子α(TNF-α)及肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、糖链抗原CA125、糖链抗原CA 15-3等疾病指标,采用SPSS 13.0统计软件进行数据分析。结果结核性胸腔积液组IFN-γ、IL-6含量及ADA水平,分别为(22.2±0.6)、(80.1±46.7)pg/ml及(53.2±9.5)μ/ml,明显高于癌性胸腔积液组(8.5±2.5)、(34.5±17.4)pg/ml及(18.9±5.0)μ/ml,CEA明显低于癌性胸腔积液组,差异有统计学意义(P0.05);选择差异有统计学意义的检测指标,通过ROC曲线分析得出各指标最佳界定值为ADA40.3U/ml,CEA15.0ng/ml,IL-647.6pg/ml,IFN-γ13.2pg/ml;用于结核性胸腔积液的诊断,IGRA敏感性为72.9%、特异性为84.0%;建立了结核性胸腔积液诊断的联合检测体系,组合效率最高的为IGRA+ADA+CEA联合检测敏感性92.4%、特异性94.5%、准确性93.2%。结论联合诊断可避免单项指标的片面化、绝对化,提高诊断的敏感性、特异性,具有重要应用价值。
[Abstract]:Objective to establish a combined detection system based on interferon 纬 release assay (IFN- 纬 release test), such as CRPX, adenosine deaminase (ADAA), tumor markers and infective cytokines. Methods 86 cases of pleural effusion with definite diagnosis and complete data from March 2011 to September 2012 were selected and divided into tuberculous pleural effusion group (59 cases) and malignant pleural effusion group (27 cases). All patients were detected with IGRA, and the disease markers, such as Ada CRP, Interleukin-2O4, Interleukin-2, Interleukin-2, IFN- 纬, TNF- 伪, carcinoembryonic antigen, cytokeratin 19 fragment CYFRA21-1, carbohydrate antigen CA125and carbohydrate chain antigen CA15-3, were evaluated and screened, respectively, and the results showed that all of the three markers were detected by IGRA, and the cancer embryo antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), carbohydrate chain antigen (CA125), carbohydrate antigen CA15-3, and so on. Results the levels of IL-6 and ADA in tuberculous pleural effusion group were 80.1 卤46.7g / ml and 53.2 卤9.5 渭 / ml, respectively, which were significantly higher than those in malignant pleural effusion group (8.5 卤2.534.5 卤17.4g / ml and 18.9 卤5.0) 渭 / ml, respectively. The difference was statistically significant (P 0.05). According to the analysis of ROC curve, the best defined value of each index was ADA40.3 U / ml CEA 15.0 ng / ml IL-647.6 PG / ml ~ (-1) IFN- 纬 13.2pg / ml, and the sensitivity and specificity of IGRA for the diagnosis of tuberculous pleural effusion were 72.9% and 84.0% respectively, and the combined detection system for diagnosis of tuberculous pleural effusion was established. The combination efficiency of IGRA ADA CEA was 92.4%, specificity 94.5 and accuracy 93.2.Conclusion combined diagnosis can avoid one-sided and absolute of single index, improve sensitivity and specificity of diagnosis, and have important application value.
【作者单位】：永康市第一人民医院感染性疾病科;
【基金】：永康市科技计划基金资助项目(201136)
【分类号】：R521.7;R730.4

【相似文献】