【作者】 王英年； 刘加洪； 孙荣丽； 张可佳； 官明德； 于华； 李黎； 张春玲；

【Author】 Wang Yingnian , Liu Jiahong , Sun Rongli, et al. The Research Institute of Tuberculosis and Respiratory Disease in Qingdao Center Hospital, Qingdao 266042

【机构】 青岛市中心医院青岛市结核肺病防治研究所；

【摘要】 目的:分别检测结核性与恶性胸腔积液中检测P-选择素、IL-10α、sFas、sFasL、AM(肾上腺髓质素) 含量暨与目前临床常用的癌胚抗原(CEA)含量比较,探讨各检测方法及联合检测在结核性与恶性胸腔积液鉴别诊断中的价值。方法:在结核性与恶性胸腔积液中,应用ELISA法检测P-选择素、IL-10α、sFas、sFasL的含量;用放射免疫法(RI A)分别检测AM与CEA含量,对所得数据进行统计学处理。结果: ①结核性胸腔积液中P-选择素、IL-10α含量均明显低于恶性胸腔积液组,分别为7.4±3.3/18.7±8.4 μg/L(p<0.01).36.4±18.7/66.8±24.9ng/L(p<0.01)。P-选择素以10 μg/L、IL-10α以50ng/L为诊断界值,对两种胸腔积液临床诊断符合率分别为84.7%、68.3%,两者联合检测临床诊断符合率为88.5%; ②结核性胸腔积液中sFas、sFasL含量均明显高于恶性胸腔积液组,分别为150.37±52.08/83.69±31.35 ng/ml(p<0.001):13.56±5.38/5.72±2.59 ng/ml(p<0.001)。sFasL以10 ng/ml、sFas以110 ng/ml为诊断界值,对两种胸腔积液临床诊断符合率分别为81.3%、70.7%,两者联合检测临床诊断符合率为88.6%; ⑤结核性胸腔积液中AM、CEA含量均明显低于恶性胸腔积液组,分别为71.40±10.80/115.05±31.06 pg/ ml(p<0.05):9.55±3.47/34.75±25.177(p<0.01)。AM以90.51 pg/mL、CEA以15 ng/mL为诊断界值, 对两种胸腔积液临床诊断符合率分别为77.8%、67.5%,两者联合检测临床诊断符合率为90.3%。结论:P-选择素、IL-10α、sFas、sFasL与AM在对结核性与恶性胸腔积液的鉴别诊断上,敏感性、特异性及临床诊断符合率均高于CEA,有较高的临床实用价值。ELISA法中以P-选择素为优,放免法以AM为优,联合检测可明显提高其临床诊断符合率。研究还提示P-选择素、IL-10α、sFas、sFasL与AM在结核性与恶性胸腔积液形成机理中起一定的作用,从而亦为其治疗研究提供了一条新思路。更多还原

【Abstract】 Objective: To explore the diagnostic values and clinical significance of detecting P-selectin, IL-1 α ,soluble Fas, soluble FasL and adrenomedullin(AM) of pleural effusions in differentiating tuberculous and malignant pleural effusions and compare with CEA . Method: The content of P-selectin, IL-1 α, soluble Fas, soluble FasL in tuberculous and malignant pleural effusions were measured by Enzyme-linked immunosorbent assay(ELISA) and the content of AM and CEA were measured by radioimmunoassay(RIA) in tuberculous and malignant pleural effusions. Results: ①The level of P-selectin and EL-1 α of tuberculous pleural effussionswas markedly lower than that of malignant pleural effusions (150.37 ± 52.08/83.69 ± 31.35 ng/ml, P<0.001; 13.56 ± 5.38/5.72 ± 2.59ng/ml, P<0.001). If P-selectin 10μg/L, IL-1α50ng/L were regarded as limit respectively, the rate of right of diagnosing tuberculous pleural effusions was 88.45%, when both were detected combinedly.② The level of sFasL and sFas of tuberculous pleural effussionswas was markedly higher than that of malignant pleural effusions (13.56 ± 5.38ng/ ml/5.72 ± 2.59ng/ml ,P<0.001; 150.37 ± 52.08/83.69 ± 31.35ng/ml, P<0.001). If sFasL 10ng/ml, sFas 110ng/ml were regarded as limit respectively, the rate of right of diagnosing tuberculous pleural effusions was 88.57%, when both sFasL and sFas were detected combinedly. ③ The level of AM and CEA of tuberculous pleural effussionswas was markedly lower than that of malignant pleural effusions (71.40 ± 10.80/115.05 ± 31.06pg/ml , p<0.05; 9.55 ± 3.47/34.75 ± 25.177, p <0.01). If regarded AM 90.51ng/ml, CEA 15 ng/ml as limit respectively, the rate of right of diagnosing tuberculous pleural effusions was 90.3%, when they were detected combinedly. Conclusion: All of P-selectin,IL-1 α ,sFas,sFasL,AM and CEA can be regarded to be relative to forming tuberculosis pleural effusion and malignant pleural effusion .The differents of level of them in pleural effusion can be used to differ effectively tuberculosis pleural effusion from malignant pleural effusion. Among them ,if ELISA was used ,P-selectin was more available, and,if RIA was used ,AM was more available.更多还原