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目的探讨联合检测胸腔积液、血清中的腺苷脱氨酶(ADA)、抗结核抗体(TB-AB)、癌胚抗原(CEA)、铁蛋白(SF)、结核分支抗酸杆菌DNA(TB-DNA)对结核性胸腔积液和癌性胸腔积液的鉴别诊断价值。方法对90例结核性胸腔积液和60例癌性胸腔积液的患者进行联合检测ADA、TB-DNA、TB-AB、SF、CEA,并计算其敏感性和特异性。结果结核性胸膜炎组的胸腔积液中ADA值高于癌性胸液组(P<0.05),TB-DNA、TB-AB阳性率高于癌性胸腔积液组(P<0.05);三种对结核性胸腔积液诊断的敏感性分别为:81.1%、58.8%、50.0%,特异性分别为:91.6%、93.3%、88.3%;结核性胸腔积液组血清中的TB-DNA、TB-AB阳性率高于癌性胸腔积液组,但血清中ADA值,二组相比差异无统计学意义;癌性胸腔积液组的血清及胸腔积液SF、CEA值均高于结核性胸腔积液组(P<0.01),SF、CEA对癌性胸腔积液诊断的敏感性分别为87.7%、97.7%,特异性分别为70.0%、98.3%。结论 ADA、TB-DNA、TB-AB、SF、CEA五种联合检测对结核性胸腔积液及癌性胸腔积液有鉴别诊断价值。
Objective To explore the clinical value of combined detection of pleural effusion, serum ADA, TB-AB, CEA, SF, TB -DNA) in the differential diagnosis of tuberculous pleural effusion and cancerous pleural effusion. Methods Ninety patients with tuberculous pleural effusion and 60 patients with malignant pleural effusion were tested for ADA, TB-DNA, TB-AB, SF, CEA, and their sensitivity and specificity were calculated. Results The pleural effusion in tuberculous pleurisy group had higher ADA than that in cancerous pleural effusion group (P <0.05). The positive rate of TB-DNA and TB-AB was higher than that in cancerous pleural effusion group (P <0.05) The diagnostic sensitivity of tuberculous pleural effusion were 81.1%, 58.8% and 50.0% respectively, the specificity were 91.6%, 93.3% and 88.3% respectively. The TB-DNA, TB -AB positive rate was higher than that of cancerous pleural effusion group, but there was no significant difference in serum ADA value between the two groups. SF and CEA of serum and pleural effusion of cancerous pleural effusion group were higher than those of tuberculous Pleural effusion group (P <0.01). The sensitivity of SF and CEA to the diagnosis of pleural effusion was 87.7% and 97.7% respectively, and the specificity was 70.0% and 98.3% respectively. Conclusion The combined detection of ADA, TB-DNA, TB-AB, SF and CEA has differential diagnostic value for tuberculous pleural effusion and cancerous pleural effusion.