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(P<0.05);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ADA>40.3U/ml,CEA<15.0ng/ml,IL-6>47.6pg/ml,IFN-γ>13.2pg/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。
OBJECTIVE To improve the identification of tubercular hydrothorax from cancer-induced hydrothorax by establishing a combined detection system with interferon-γrelease test（IGRA）,C-reactive protein（CRP）,adenosine deaminase enzyme（ADA）,tumor markers and infection-related cytokines.METHODS A total of 86 patients with hydrothorax were divided into tubercular hydrothorax group（59 cases）and cancer-induced hydrothorax group（27cases）.All the patients were comprehensively evaluated,screened by IGRA,ADA,CRP,infection-related cytokines（IL-2,4,6,10,IFN-γ,TNF-α）and tumor markers（CEA,CYFRA21-1,CA125,CA15-3）.RESULTS The concentration of IFN-γ,IL-6 and ADA in tubercular hydrothorax group were significantly higher than those of cancer-induced hydrothorax group（P〈0.01）;the concentration of CEA in tubercular hydrothorax group was significantly lower than that of cancer-induced hydrothorax group（P〈0.01）.According to the analysis of ROC curves,the cut-off values were defined（ADA〉40.3U/ml,CEA〈15.0ng/ml,IL-6〉47.6pg/ml,IFN-γ〉13.2pg/ml）.The sensitivity and specificity of IGRA in tubercular hydrothorax group were 72.9% and 84.0%.The detection system was established and the highest efficiency was achieved by combing IGRA,ADA and CEA（sensitivity=92.4%,specificity=94.5%,accuracy=93.2%）.CONCLUSION The combined detection system has important diagnostic values.It can avoid the shortcomings of single index and improve the sensitivity and specificity.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第19期4787-4789,共3页
Chinese Journal of Nosocomiology
基金
永康市科技计划基金资助项目(201136)
