胸腔积液胆固醇测定对判定胸液性质及病因的临床研究

发布时间：2018-06-27 02:35

本文选题：胸水胆固醇 + 渗出液　；参考：《延安大学》2017年硕士论文

【摘要】：目的:探讨胸水胆固醇(Pch)、胸水胆固醇与血清胆固醇的比值(P/Sch)在判定胸腔积液渗、漏出液性质及胸水良、恶性中的应用价值。方法:收集2014年12月至2016年12月因胸腔积液在延安大学附属医院住院治疗病例资料,在患者入院后3天内行胸膜腔穿刺术进行胸水标本的采集、入院次日清晨空腹采集血清标本,送检胸水常规、胸水生化、Pch及Sch。然后进一步计算出P/Sch。Pch、P/Sch分别按性别、年龄段、胸水的渗漏性质、胸水的病因进行分组比较,若对胸水渗漏性质及胸水良恶性质的鉴别有意义时,进一步分析制作受试者工作特征曲线(ROC曲线),并计算出其诊断界值、敏感度、特异度。结果:本次研究共收集221例胸腔积液病例,45岁以下(~45)的63例,45~65岁之间(45~65)的72例,65岁以上(65~)的有86例;恶性胸水61例,良性胸水160例(结核84例、肺炎18例、心源性53例、肝源性2例、肾源性3例);渗出液155例,漏出液52例,界于渗漏之间14例。1.恶性胸水和良性胸水在三个年龄段(~45、45~65、65~)分布的差异存在统计学意义(P0.05);良性胸水在~45、45~65的比例高于65~,恶性胸水在~45、45~65的比例低于65~(P0.05)。2.渗出性与漏出性胸水中Pch(2.55±0.08 vs.0.86±0.41,P0.05)、P/Sch(0.63±0.19vs.0.24±0.18,P0.05)的差异均有统计学意义,渗出液中Pch、P/Sch要显著高于漏出液。3.Pch、P/Sch在鉴别胸水渗漏性质中的诊断效能显示,Pch、P/Sch分别以1.72、0.41为诊断界值,特异度分别为0.99、0.98,敏感度分别为0.97、0.99,ROC中的曲线下面积分别为0.97、0.98。4.恶性胸水中男、女性Pch(2.78±0.86 vs.2.64±1.30,P0.05)、P/Sch(0.68±0.16 vs.0.63±0.11,P0.05)差异均无统计学意义;良性胸水中男、女性Pch(2.68±0.36vs.2.61±0.42,P0.05)、P/Sch(0.53±0.12 vs.0.56±0.14,P0.05)差异均无统计学意义。5.~45、45~65岁的患者中恶性、结核性、肺炎性胸水Pch、P/Sch的差异无统计学意义(P0.05)。6.65~岁的患者中恶性、结核性、肺炎性胸水的Pch(2.94±0.61 vs.2.29±0.53 vs.2.31±0.40,P0.05)、P/Sch(0.73±0.10 vs.0.60±0.19 vs.0.61±0.11 P0.05)差异有有统计学;进一步行两两比较,结果示恶性胸水P/Sch、Pch水平要高于结核性、肺炎性胸水(P0.05),结核性胸水P/Sch、Pch与肺炎性胸水差异无统计学意义(P0.05)。7.老年(65~)渗出性胸水患者中Pch与Sch不存在线性相关。8.Pch、P/Sch鉴别老年胸水良恶性质中的诊断效能分析,结果显示Pch、P/Sch在ROC中的曲线下面积分别为0.74、0.76,Pch的诊断界值为3.18,特异度为0.88,敏感度为0.78;P/Sch的诊断界值为0.71,特异度为0.83,敏感度为0.77。结论:1.Pch、P/Sch在判定胸腔积液渗漏性质中具有一定的诊断价值,灵敏度、特异度均较高。2.Pch、P/Sch在鉴别胸腔积液良恶性质中,65岁以下的患者未发现有应用价值,在65岁以上的患者中有一定的参考价值。
[Abstract]:Objective: to investigate the value of pleural effusion cholesterol (Pch), the ratio of pleural effusion cholesterol to serum cholesterol (P / Sch) in the diagnosis of pleural effusion, the nature of effusion and the benign and malignant pleural effusion. Methods: the data of patients with pleural effusion were collected from December 2014 to December 2016 in the affiliated Hospital of Yan'an University. Pleural puncture was performed within 3 days after admission to collect pleural effusion samples. Serum samples were collected on an empty stomach the next day after admission. Pleural effusions were examined for routine, biochemistry, Pch and Sch. Then we further calculated that P / Sch.Pchn / P / Sch was divided into two groups according to sex, age, hydrothorax leakage, and the etiology of pleural effusion. If it is meaningful to distinguish the effusion from the benign and malignant characteristics of pleural effusion, Furthermore, the operating characteristic curve (ROC curve) was made and its diagnostic threshold, sensitivity and specificity were calculated. Results: a total of 221 cases of pleural effusion were collected in this study. Among the 221 cases of pleural effusion under 45 years old (45 years old), there were 63 cases between 45 and 65 years of age (65 ~ 65 years old), 61 cases of malignant pleural effusion and 160 cases of benign pleural effusion (84 cases of tuberculosis, 18 cases of pneumonia, 53 cases of cardiogenic disease), 86 cases of malignant pleural effusion and 160 cases of benign pleural effusion (84 cases of tuberculosis, 18 cases of pneumonia and 53 cases of cardiogenic disease). Hepatogenic 2 cases, kidney 3 cases), exudate 155 cases, leakage 52 cases, between leakage 14 cases. The distribution of malignant pleural effusion and benign pleural effusion in three age groups was statistically significant (P0.05), the proportion of benign pleural effusion was higher than 65%, and the proportion of malignant pleural effusion was lower than 65 ~ (P0.05) .2. The difference of Pch between effusion (2.55 卤0.08 vs.0.86 卤0.41g) and effusion (0.63 卤0.19vs.0.24 卤0.18p0.05) was statistically significant. The diagnostic efficacy of PchG / P / Sch in effusion was significantly higher than that in effusion .3.The diagnostic efficacy of Pch / Sch in distinguishing the leakage of pleural effusion showed that the diagnostic limit value of Pch / Sch was 1.72 / 0.41, respectively. The specificity and sensitivity of ROC were 0.99 and 0.98, respectively. The area under the curve of ROC was 0.97 ~ 0.98.4, respectively. There was no significant difference between male and female Pch (2.78 卤0.86 vs.2.64 卤1.30p0.05) in malignant pleural effusion (0.68 卤0.16 vs.0.63 卤0.11p0.05), but there was no significant difference between male and female in benign pleural effusion (2.68 卤0.36vs.2.61 卤0.42p0.05) and Pp-Sch (0.53 卤0.12 vs.0.56 卤0.14p0.05). There was no significant difference of Pch / Sch in pneumonic pleural effusion (P0.05) .6.65 ~ year old patients with malignant, tuberculous and pneumonic pleural effusion (2.94 卤0.61 vs.2.29 卤0.53 vs.2.31 卤0.40P05). There was a significant difference in P / Sch between malignant pleural effusion and tuberculous pleural effusion (0.73 卤0.10 vs.0.60 卤0.19 vs.0.61 卤0.11 P0.05), the results showed that the level of Pch in malignant pleural effusion was higher than that in tuberculous pleural effusion. Pneumonic pleural effusion (P0.05), tuberculous pleural effusion P / S Schnn Pch and pneumonic pleural effusion had no significant difference (P0.05). 7. There was no linear correlation between Pch and Sch in the elderly patients with effusion. 8. The diagnostic efficacy of Pch / Sch in differentiating benign and malignant characteristics of senile pleural effusion. The results showed that the area under the curve of Pchchon P / Sch in ROC was 0.74 卤0.76 and the diagnostic threshold value was 3.18, the specificity was 0.88, the sensitivity of 0.78 P / Sch was 0.71, the specificity was 0.83 and the sensitivity was 0.77. Conclusion: 1. Pchchon P / Sch has certain diagnostic value in determining pleural effusion leakage. The sensitivity and specificity are higher. 2.Pchchon P / Sch has no application value in differentiating benign and malignant pleural effusion patients under 65 years old. It has certain reference value in patients over 65 years old.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R561.3

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