ADA和有核细胞计数联合检测鉴别结核性胸膜炎和类肺炎性胸腔积液的临床价值研究

发布时间：2018-03-07 02:07

本文选题：结核性胸膜炎　切入点：类肺炎性胸腔积液　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:结核性胸膜炎和类肺炎性胸腔积液是临床上引起胸腔积液的常见病因,然而目前国内关于二者鉴别的胸水实验室检测指标研究相对较少。故本文旨在通过检测胸腔积液中腺苷脱氨酶(ADA)和有核细胞计数水平,研究ADA、有核细胞计数以及二者联合检测鉴别结核性胸膜炎和类肺炎性胸腔积液的临床价值。方法:回顾性收集2010年12月至2017年3月在山东省立医院东院呼吸科住院的胸腔积液患者175例,其中经内科胸腔镜活检确诊或经临床诊断的结核性胸膜炎64例、类肺炎性胸腔积液41例、恶性胸腔积液54例、其他病因(低白蛋白血症、肺栓塞、结缔组织病相关、寄生虫)等引起胸腔积液16例。对比分析同类型胸腔积液中ADA及有核细胞计数的水平并应用ROC曲线评价ADA和有核细胞计数对于结核性胸膜炎和类肺炎性胸腔积液的鉴别诊断价值。结果:1.不同性质胸腔积液中ADA含量比较及分析结核性胸膜炎患者胸腔积液ADA测定值为36.9± 10.7U/L;类肺炎性胸腔积液ADA测定值为56.7±15.85.恶性胸腔积液组患者胸腔积液胸腔积液ADA测定值为11.6±3.5U/L类肺炎性胸腔积液ADA水平显著高于结核性胸膜炎组和恶性胸腔积液组,结核性胸膜炎组显著高于恶性胸腔积液组,三者比较均有统计学差异。2.不同性质胸腔积液有核细胞计数比较及分析结核性胸膜炎患者胸腔积液有核细胞计数测定值为2951.5±375.2*10^6个/L;类肺炎性胸腔积液有核细胞数测定值为35858.3±1679.3*10^6个/L;恶性胸腔积液组有核细胞计数测定值为2279.9±269.3*10^6个/L。类肺炎性胸腔积液患者胸水中有核细胞计数显著高于结核性胸膜炎与恶性胸腔积液组,结核性胸膜炎组与恶性胸腔积液组无显著差异。3.以1-特异性为x轴,敏感度为y轴绘制roc曲线,ADA联合有核细胞计数检测(AUC=0.826)优于单独检测有核细胞计数(AUC=0.477)(P0.05),但与单独检测ADA(AUC=0.776)无显著性差异(p0.05)。ADA检测结核性胸膜炎临界值为18.15U/L,此时检测结核性胸膜炎的敏感度为0.891,特异性为0.695;有核细胞计数对于诊断结核性胸膜炎意义不大。4.ADA联合有核细胞计数(AUC=0.724)检测类肺炎性胸腔积液优于单独检测ADA(AUC=0.626)(p0.05);但与单独检测有核细胞计数(AUC=0.703)差异不明显(p0.05)。有核细胞计数最佳诊断临界值为6249.5*10^6个/L,此时敏感度为0.512,特异度为0.932;ADA最佳诊断临界值为63U/L,此时敏感度为0.317,特异度为0.975。5.根据roc曲线得出的ADA与有核细胞计数的临界值,将两种指标进行组合发现:18.15U/LADA63U/L且有核细胞计数6250*10^6个时/L时对于诊断结核性胸膜炎的灵敏度和特异性均达96.9,阳性预测率达95.4,阴性预测率达97.9;ADA≥63U/L且有核细胞计数≥6250*10^6个/L时对于诊断类肺炎性胸腔积液灵敏度为21.9,特异性达95.8,阳性预测率为64.3,阴性预测率为77.9;ADA≤18.15U/L且有核细胞数6250*10^6个/L时诊断恶性胸腔积液的灵敏度达88.9,特异性达82.6,阳性预测率为70.6,阴性预测率达94.1。结论:1.利用胸腔积液实验室检查指标对胸腔积液性质进行早期诊断对于当前的临床工作仍有很高实用价值。单一利用胸腔积液的某一指标鉴别其不明原因胸腔积液性质具有一定的局限性,但联合利用有限的指标则可以在一定程度上提高诊断效能。2.利用受试者工作特征曲线计算临界值划定诊断标准,将ADA和有核细胞计数进行组合,结核性胸膜炎诊断的敏感性和特异性都达到了96.9%,阳性和阴性预测率分别达到了 95.4和97.9,值得临床应用推广。3.ADA含量在结核性胸膜炎和类肺炎性胸腔积液中均有升高,二者升高程度不同,类肺炎性胸腔积液ADA含量显著高于结核性胸膜炎。4.本研究中所检测的ADA诊断结核性胸膜炎临界值为18.5U/L,低于既往公认的ADA40U/L,与国内外相关研究结果类似。5.在诊断类肺炎性胸腔积液时,有核细胞计数表现了很高的特异性,值得临床重视,并进行大样本量分析获得更准确的诊断临界值。
[Abstract]:Objective: tuberculous pleurisy and pleural effusion is the most common cause of pleural effusion in clinic, but currently on the two identification of hydrothorax laboratory research is relatively small. Therefore, this paper aims at the detection of adenosine deaminase in pleural effusion (ADA) and nuclear cell counts, ADA, clinical value the number of the nucleated cells and two differential diagnosis of tuberculous pleurisy and pleural effusion. Methods: retrospectively collected from December 2010 to March 2017 in 175 pleural effusion patients hospitalized in the Department of respiration of Shangdong Province-owned Hospital of Eastern Hospital, which through medical thoracoscopy biopsy or clinical diagnosis of tuberculous pleurisy in 64 cases, 41 cases of type pleural effusion, 54 cases of malignant pleural effusion, other etiologies (hypoalbuminemia, pulmonary embolism, connective tissue disease, parasites) induced pleural effusion in 16 Cases. Compared with the type of ADA in pleural effusion and nucleated cell count level and to evaluate the application of ROC ADA curve and nucleated cell count in the differential diagnosis of tuberculous pleurisy and pleural effusion. Results: 1. different kinds of ADA in pleural effusion were compared and analysis of tuberculous pleurisy pleural effusion in patients with ADA measured value was 36.9 + 10.7U/L; pleural effusion ADA determination of the values of 11.6 + 3.5U/L for pleural effusion ADA levels were significantly higher in tuberculous pleurisy group and malignant pleural effusion group was 56.7 + 15.85. group of malignant pleural effusion in patients with pleural effusion pleural effusion ADA, tuberculous pleurisy group was significantly higher than that of malignant pleural effusion group three, there were significant differences between the.2. of pleural effusion nucleated cell count comparison and analysis of patients with tuberculous pleurisy pleural effusion nucleated cell count determination A value of 2951.5 + 375.2*10^6 /L; pleural effusion cells was 35858.3 + 1679.3*10^6 for /L; malignant pleural effusion group nucleated cell count values were 2279.9 + 269.3*10^6 /L. parapneumonic pleural effusion in patients with nucleated cell count was significantly higher than that of tuberculous pleurisy and malignant pleural effusion. Group, tuberculous pleurisy and malignant pleural effusion group.3. had no significant difference in the specificity of 1- for the X axis, Y axis sensitivity of ROC curve, ADA and nucleated cell count assay (AUC=0.826) detection is better than the single nucleated cell count (AUC=0.477) (P0.05), but with the separate detection of ADA (AUC=0.776) no significant differences (P0.05).ADA detection of tuberculous pleurisy critical value is 18.15U/L, the detection of tuberculous pleurisy sensitivity was 0.891, specificity was 0.695; nucleated cell count for the diagnosis of tuberculous pleurisy is.4.A DA combined with the number of the nucleated cell (AUC=0.724) detection of pleural effusion is better than the single detection of ADA (AUC=0.626) (P0.05); but the number of the nucleated cell and single detection (AUC=0.703) was not significantly different (P0.05). The number of the nucleated cell of the optimal diagnostic critical value was 6249.5*10^6 /L, with a sensitivity of 0.512,. The specificity is 0.932 ADA; the optimal diagnostic critical value was 63U/L, with a sensitivity of 0.317, specificity of the critical value of 0.975.5. according to the ROC curve of ADA and nucleated cell count, two indicators were found: 18.15U/LADA63U/L combination and nucleated cell counts 6250*10^6 /L when the sensitivity and specificity of the diagnosis of tuberculous pleurisy was 96.9, the positive predictive rate was 95.4, the negative predictive rate was 97.9; ADA = 63U/L and nucleated cell count is greater than or equal to 6250*10^6 /L for the diagnosis of pleural effusion sensitivity was 21.9, specificity was 95.8, positive pre Detection rate was 64.3, the negative predictive rate was 77.9; the sensitivity of diagnosis of malignant pleural effusion ADA less than 18.15U/L and the number of nucleated cells 6250*10^6 /L was 88.9, the specificity was 82.6, the positive predictive value was 70.6, negative predictive rate was 94.1. conclusion: 1. by pleural effusion index of laboratory examination for early diagnosis of pleural effusion there is still a high practical value in clinical work. The use of a single index in differential diagnosis of pleural effusion of the unexplained pleural effusion has certain limitations, but the combined use of limited targets in a certain extent, improve the diagnostic efficiency.2. using receiver operating characteristic curve calculation of critical value of diagnostic criteria can be delineated. ADA and the number of the nucleated cells were combined, the diagnosis of tuberculous pleurisy. The sensitivity and specificity was 96.9%, positive and negative predictive rate reached 95.4 and 97.9, which is worthy of The bed application content of.3.ADA in tuberculous pleurisy and pleural effusion increased in two, increased to different degrees, pleural effusion ADA levels were significantly higher than that of tuberculous pleurisy.4. detected in this study of ADA diagnosis of tuberculous pleurisy is lower than the critical value is 18.5U/ L, previously recognized ADA40U/L, at home and abroad the related research results similar to.5. in the diagnosis of pleural effusion, nucleated cell count showed high specificity, it is worthy of attention, and analyze the large amount of critical value more accurate diagnosis.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521.7;R561.3

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