【摘要】 目的探讨ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测对结核性胸膜炎的诊断价值。方法检测56例已经经组织病理学或病原学明确诊断的结核性胸膜炎患者,20例经细胞学或组织病理学明确诊断的恶性胸腔积液患者,以及12例其他渗出性胸腔积液患者的胸液和血清中的ADA活性和IFN-γ含量以及抗结核分枝杆菌抗体阳性率,经统计学处理后,评价各项指标对结核性胸膜炎诊断的灵敏度、特异度及临床诊断符合率。结果结核性胸液中ADA活性、IFN-γ含量分别为(50.98±13.07)U/L、(139.46±70.43)pg/ml,结核分枝杆菌抗体阳性率60.7%,与恶性胸液组和其他组比较差别有统计学意义,P<0.05。以45 U/L为临界值,ADA对结核性胸膜炎诊断的灵敏度为80.4%,特异度96.9%,临床诊断符合率为86.4%;IFN-γ以100pg/ml为临界值对结核性胸膜炎诊断的灵敏度为83.9%,特异度93.8%,临床诊断符合率为87.5%;胸液中结核分枝杆菌抗体检测对结核性胸膜炎诊断的灵敏度为60.7%,特异度为87.5%,临床诊断符合率为70.5%。以3项指标联合检测任何2项阳性对结核性胸膜炎诊断的灵敏度为92.9%,特异度100%,临床诊断符合率为95.5%。结论ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测可极大地提高结核性胸膜炎的诊断效能。更多还原

【Abstract】 Objective To explore the diagnostic value of adenosine deaminase(ADA) activity,IFN-γ level and Tb-Ab-IgG expression in tuberculous pleurisy.Methods Fifty-six patients with tubercular pleural effusion,20 patients with malignant pleural effusion and 12 patients with other pleural effusion were recruited.ADA activity,IFN-γ level and TB-Ab-IgG were detected from pleural effusion and peripheral blood among these patients.Results The mean levels of ADA,IFN-γ in tubercular pleural effusion were(50.98±13.07)U/L and(139.46±70.43)pg/ml.They were significantly higher than those in malignant effusion which were(10.88±9.22)U/L and(12.15±9.31)pg/ml respectively(P<0.001),and significantly higher than those in the other pleural effusion too(P<0.001).The positive rate of TB-Ab-IgG in tubercular pleural effusion were 60.7%,it was significantly higher than that in other two groups(P<0.05).When 45U/L was regarded as cut off value for ADA,the sensitivity and specificity for ADA in the diagnosis of tuberculous pleurisy were 80.4% and 96.9% respectively.The coincidence rate of clinical diagnosis was 86.4%.If 100 pg/ml was regarded as cut off value for IFN-γ in tubercular pleural effusion,the sensitivity and specificity were 83.9% and 93.8% respectively.The coincidence rate of clinical diagnosis was 87.5%.The sensitivity and specificity for TB-Ab-IgG were 60.7% and 87.5%.The coincidence rate of clinical diagnosis was 70.5%.The combined detection of the three markers for diagnosis of tuberculous pleurisy had a sensitivity of 92.9% and a specificity of 100%.The coincidence rate of clinical diagnosis was 95.5%.Conclusion The accuracy of diagnosis for tuberculous pleurisy was significantly improved with combined detection of ADA,IFN-γ and TB-Ab-IgG.更多还原