γ-干扰素释放试验、IL-6水平对结核、恶性胸腔积液的鉴别价值研究

发布时间：2018-06-10 02:47

本文选题：内科胸腔镜 + γ-干扰素释放试验　；参考：《河北大学》2017年硕士论文

【摘要】：目的:研究外周血、胸腔积液γ-干扰素释放试验(Interon-gama Release Assays.IGRAs)和血清、胸腔积液IL-6(Interleukin-6.IL-6)水平检测对于鉴别结核性与恶性胸腔积液的临床价值。方法:对在2015-7至2016-12期间于我院呼吸科住院的106例渗出性胸腔积液患者行内科胸腔镜检查。根据其病理结果,排除不符合标准的病例,最终纳入结核性胸膜炎(Tuberculous pleural effusion.TPE)患者49例和恶性胸腔积液(Malignant pleural effusion.MPE)患者37例。对纳入患者的T-SPOT.TB和IL-6检测的结果进行收集、统计。对T-SPOT.TB检测和IL-6检测的结果进行组间和组内比较,以测得两组间检测指标的水平差异。绘制受试者工作特征曲线(ROC曲线),根据曲线下面积比较各个检测指标的诊断效能。并且测得最佳诊断临界值,计算灵敏度、特异度、准确度、阳性预测值、阴性预测值以评估诊断指标的临床应用价值。结果:1.TPE组外周血、胸腔积液的T-SPOT.TB的斑点形成细胞(SFC,Spots forming cell)数量均明显高于MPE组,并且,TPE组胸腔积液的SFC数量明显高于外周血的SFC数量,差异均具有统计学意义。2.TPE组血清、胸腔积液中的IL-6水平均高于MPE组。并且,TPE组胸腔积液中的IL-6水平明显高于血清IL-6水平,差异均具有统计学意义。3.外周血、胸腔积液T-SPOT.TB、IL-6水平的ROC曲线下面积分别为0.709、0.910、0.660、0.875,胸腔积液T-SPOT.TB、IL-6水平检测的诊断价值最高,其灵敏度、特异度、准确率、最佳临界值分别为85.7%、81.1%、83.7%、217/2.5×105,85.7%、78.4%、82.6%、226pg/ml。4.胸腔积液T-SPOT.TB与胸腔积液IL-6平行联合检测时的敏感度、特异度是91.8%、62.1%,其敏感度较两项单独检测无明显统计学意义(2c=1.33,P=0.25;X~2=1.33,P=0.25),系列联合检测时的敏感度和特异度分别为79.6%、97.3%。其特异度与T-SPOT.TB和IL-6相比均升高,差异具有统计学意义(X~2=4.17,P=0.04;X~2=5.14,P=0.02)。结论:1.利用内科胸腔镜可以直视不同类型胸腔积液患者胸膜的形态学的改变,内科胸腔镜术是一项直观、高效、安全的检测技术,值得被广泛推广应用。2.T-SPOT.TB、IL-6水平检测对鉴别结核性和恶性胸腔积液均具有一定的应用价值,其中,胸腔积液T-SPOT.TB、IL-6检测的应用价值更高。两项检测系列联合对疾病的排除意义更大,T-SPOT.TB、IL-6水平检测及两项检验联合检测可以在临床上作为辅助检测手段.3.T-SPOT.TB的价格较高、技术要求高,基层医院及偏远平困地区人群应用可能会受到限制。
[Abstract]:Objective: to study the clinical value of Interon-gama release Assays.IGRAsand serum and IL-6 interleukin-6.IL-6 in peripheral blood and pleural effusion for differential diagnosis of tuberculous and malignant pleural effusion. Methods: 106 patients with exudative pleural effusion were examined by internal thoracoscopy during the period of 2015-7 to 2016-12. According to the pathological results, 49 cases of tuberculous pleural effusion.TPE and 37 cases of malignant pleural effusion pleural effusion.MPE) were excluded. The results of T-SPO T.TB and IL-6 were collected and counted. The results of T-SPOT.TB and IL-6 were compared between groups and within groups. The ROC curve was drawn and the diagnostic efficiency of each index was compared according to the area under the curve. The best diagnostic critical value, computational sensitivity, specificity, accuracy, positive predictive value and negative predictive value were obtained to evaluate the clinical application value of the diagnostic index. Results 1. The number of T-SPOT.TB forming cells in peripheral blood and pleural effusion in TPE group was significantly higher than that in MPE group, and that in TPE group was significantly higher than that in peripheral blood group (P < 0.05). The level of IL-6 in pleural effusion was higher than that in MPE group. The level of IL-6 in pleural effusion in TPE group was significantly higher than that in serum, and the difference was statistically significant. The areas under the ROC curve of T-SPOT.TBU IL-6 in peripheral blood and pleural effusion were 0.709 / 0.910 / 0.660,0.875, respectively. The diagnostic value, sensitivity, specificity, accuracy and the best critical value of T-SPOT.TBU IL-6 level in pleural effusion were 85.71.1and 83.71.21% 2172.5 脳 105.7mg / ml, 82.6pgml.4respectively. The sensitivity of parallel combined detection of T-SPOT.TB and IL-6 in pleural effusion was 91.80.The sensitivity of T-SPOT.TB and IL-6 in pleural effusion was 91.80.The sensitivity of T-SPOT.TB and IL-6 in pleural effusion was not statistically significant compared with that of two tests alone. The sensitivity and specificity of the series of combined tests were 79.6m7.3g. Compared with T-SPOT.TB and IL-6, the specificity was significantly higher than that of T-SPOT.TB and IL-6, and the difference was statistically significant. Conclusion 1. The morphologic changes of pleura of patients with different types of pleural effusion can be directly observed by internal thoracoscopy, which is an intuitionistic, efficient and safe detection technique. It is worthy to be widely used. 2. The detection of IL-6 in T-SPOT.TBU has a certain application value in differentiating tuberculous and malignant pleural effusion, among which, the detection of T-SPOT.TBOIL-6 in pleural effusion is more valuable in the diagnosis of tuberculous and malignant pleural effusion. The combination of two test series is of greater significance to the elimination of diseases. The detection of IL-6 level of T-SPOT.TBU and the combined detection of two tests can be used as a means of assistant detection in clinic. 3. The price of T-SPOT.TB is relatively high, and the technical requirements are high. Basic-level hospitals and remote poor areas may be restricted in the use of the population.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521.7;R730.43

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