ADA、LDH、CEA和间皮细胞计数对渗出性胸腔积液的鉴别价值
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摘要
目的探讨渗出性胸腔积液常见的病因及腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)和间皮细胞计数对渗出性胸腔积液常见病因的鉴别价值。方法回顾性分析107例渗出性胸腔积液患者的临床资料,患者胸水及血清ADA、LDH水平采用全自动生化分析仪测定,血清及胸水CEA水平采用化学发光法测定,同时进行胸水间皮细胞计数。结果结核性胸膜炎52例(结核组),恶性胸腔积液33例(恶性组),类肺炎性胸腔积液8例(感染组),其他原因的14例。结核组中胸水的ADA、LDH含量和间皮细胞计数与感染组和恶性组相比差异均有统计学意义(P<0.05或0.01);恶性组中LDH含量低于感染组(P<0.05);恶性组血清CEA值及胸水CEA/血清CEA比值较感染组及结核组显著升高(P<0.01)。结论结核、恶性肿瘤、感染仍然是渗出性胸腔积液的三大主要病因;ADA、LDH、CEA和间皮细胞计数等检查,对渗出性胸腔积液的病因有较大的鉴别价值。
Objective To explore the common causes of exudative pleural effusion and the differential diagnostic value of adenosine deaminase( ADA),lactate dehydrogenase( LDH),carcinoembryonic antigen( CEA) and mesothelial cell counts in patients with exudative pleural effusion. Methods The clinical data of 107 patients with exudative pleural effusion were analysed retrospectively.The levels of ADA and LDH in pleural effusion and serum were determined by automatic biochemical analyzer,and the levels of CEA in serum and pleural effusion were determined by chemiluminescence method,and the counts of mesothelial cells in pleural fluid was also determined.Results There were 52 cases of tuberculous pleurisy( tuberculous group),33 cases of malignant pleural effusion( malignant group),8 cases of pneumonic pleural effusion( infection group)and 14 cases of other reasons.The contents of ADA,LDH and mesothelial cell counts in tuberculous group were statistically significant compared with those of the infection group and malignant group( P<0.05 or 0.01).The LDH content of the malignant group was lower than that of the infection group( P<0.05). In addition,the level of serum CEA and the ratio of pleural fluid CEA/serum CEA in malignant group were significantly higher than those in the infection group and the tuberculosis group( P<0.01).Conclusion Tuberculosis,malignant tumor and infection infection are still three main causes of exudative pleural effusion.Detection of ADA,LDH,CEA and mesothelial cell counts has great differential value of etiology in exudative pleural effusion.
Objective To explore the common causes of exudative pleural effusion and the differential diagnostic value of adenosine deaminase( ADA),lactate dehydrogenase( LDH),carcinoembryonic antigen( CEA) and mesothelial cell counts in patients with exudative pleural effusion. Methods The clinical data of 107 patients with exudative pleural effusion were analysed retrospectively.The levels of ADA and LDH in pleural effusion and serum were determined by automatic biochemical analyzer,and the levels of CEA in serum and pleural effusion were determined by chemiluminescence method,and the counts of mesothelial cells in pleural fluid was also determined.Results There were 52 cases of tuberculous pleurisy( tuberculous group),33 cases of malignant pleural effusion( malignant group),8 cases of pneumonic pleural effusion( infection group)and 14 cases of other reasons.The contents of ADA,LDH and mesothelial cell counts in tuberculous group were statistically significant compared with those of the infection group and malignant group( P<0.05 or 0.01).The LDH content of the malignant group was lower than that of the infection group( P<0.05). In addition,the level of serum CEA and the ratio of pleural fluid CEA/serum CEA in malignant group were significantly higher than those in the infection group and the tuberculosis group( P<0.01).Conclusion Tuberculosis,malignant tumor and infection infection are still three main causes of exudative pleural effusion.Detection of ADA,LDH,CEA and mesothelial cell counts has great differential value of etiology in exudative pleural effusion.
引文
[1]钟南山,刘又宁.呼吸病学[M].2版.北京:人民卫生出版社,2012:798-814.
[2]周灵,时国朝,万欢英.胸腔积液中渗出液与漏出液鉴别诊断新进展[J].临床肺科杂志,2008,13(12):1627-1629.
[3]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:120.
[4]陈效友.结核性胸膜炎诊疗进展[J].临床内科杂志,2015,32(10):659-663.
[5]钟敏华,胡克.449例成人胸腔积液的临床特点分析[J].内科急危重症杂志,2016,22(4):300-301,311.
[6]李向南,张国俊.恶性胸腔积液治疗进展[J].肿瘤基础与临床,2015,28(1):84-86.
[7]伍燕兵,杜莹,逯勇,等.胸腔积液病因分析[J].中国呼吸与危重监护杂志,2017,16(5):490-494.
[8]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[9]李微蕾,郑辉才.结核性胸腔积液的实验室检查进展[J].现代医药卫生,2016,32(20):3159-3162.
[10]马清光,李慧敏,李红英.胸水腺苷脱氨酶对结核性胸膜炎诊断价值的Meta分析[J].临床荟萃,2017,32(6):523-527.
[11]Gui X,Xiao H.Diagnosis of tuberculosis pleurisy with adenosine deaminase(ADA):a systematic review and meta-analysis[J].Int J Clin Exp Medicine,2014,7(10):3126-3135.
[12]蔡柏蔷,李龙芸.协和呼吸病学[M].北京:中国协和医科大学出版社,2011:1675-1676.
[13]吴树才,张玲,张新,等.结核性胸膜炎研究进展[J].临床荟萃,2016,31(10):1048-1053,1057.
[14]黄鑫炎,谢灿茂.胸腔积液的诊断进展——诊断思路[J].内科急危重症杂志,2012,18(3):129-133.
[15]Wang XF,Wu YH,Wang MS,et al.CEA,AFP,CA125,CA153 and CA199 in maligant pleural effusions predict the cause[J].Asian Pac J Cancer Prev,2014,15(1):363-368.
[16]Antonangelo L,Sales RK,CoráAP,et al.Pleural fluid tumour markers in malignant pleural effusion with inconclusive cytologic results[J].Curr Oncol,2015,22(5):e336-e341.
[17]祁明浩.胸腔积液间皮细胞计数对结核性、恶性胸腔积液的鉴别诊断分析[J].中国乡村医药杂志,2009,16(2):58.
[18]杨柯,张益辉,王泽球,等.胸水间皮细胞计数对良、恶性胸腔积液的鉴别诊断[J].临床肺科杂志,2006,11(3):341-342.
[19]巫天贤,金雪文.腺甘脱氨酶和间皮细胞计数在鉴别结核性与恶性胸水中的价值[J].温州医学院学报,2012,42(6):580-582.
[20]殷宗宝,谭元,陈彦凡,等.癌胚抗原和腺苷脱氨酶水平及间皮细胞计数对恶性与结核性胸腔积液的鉴别诊断价值[J].中国全科医学,2009,12(3B):450-452.
[21]刘颖,于素卿.血清和胸水CEA在结核性胸膜炎和恶性胸水患者中的表达及临床意义[J].包头医学,2016,40(1):13-14.
[22]Deeba F,Khatun S,Alam MM,et al.Serum LDH and CA-125:Markers for Diagnosis of Ovarian Malignancy[J].Mymensingh Med J,2015,24(2):334-340.
[23]陈晓菊,谢明智,裴思雅,等.胸腔积液肿瘤标记物检测的临床价值探讨[J].转化医学电子杂志,2017,4(5):40-43.
[2]周灵,时国朝,万欢英.胸腔积液中渗出液与漏出液鉴别诊断新进展[J].临床肺科杂志,2008,13(12):1627-1629.
[3]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:120.
[4]陈效友.结核性胸膜炎诊疗进展[J].临床内科杂志,2015,32(10):659-663.
[5]钟敏华,胡克.449例成人胸腔积液的临床特点分析[J].内科急危重症杂志,2016,22(4):300-301,311.
[6]李向南,张国俊.恶性胸腔积液治疗进展[J].肿瘤基础与临床,2015,28(1):84-86.
[7]伍燕兵,杜莹,逯勇,等.胸腔积液病因分析[J].中国呼吸与危重监护杂志,2017,16(5):490-494.
[8]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[9]李微蕾,郑辉才.结核性胸腔积液的实验室检查进展[J].现代医药卫生,2016,32(20):3159-3162.
[10]马清光,李慧敏,李红英.胸水腺苷脱氨酶对结核性胸膜炎诊断价值的Meta分析[J].临床荟萃,2017,32(6):523-527.
[11]Gui X,Xiao H.Diagnosis of tuberculosis pleurisy with adenosine deaminase(ADA):a systematic review and meta-analysis[J].Int J Clin Exp Medicine,2014,7(10):3126-3135.
[12]蔡柏蔷,李龙芸.协和呼吸病学[M].北京:中国协和医科大学出版社,2011:1675-1676.
[13]吴树才,张玲,张新,等.结核性胸膜炎研究进展[J].临床荟萃,2016,31(10):1048-1053,1057.
[14]黄鑫炎,谢灿茂.胸腔积液的诊断进展——诊断思路[J].内科急危重症杂志,2012,18(3):129-133.
[15]Wang XF,Wu YH,Wang MS,et al.CEA,AFP,CA125,CA153 and CA199 in maligant pleural effusions predict the cause[J].Asian Pac J Cancer Prev,2014,15(1):363-368.
[16]Antonangelo L,Sales RK,CoráAP,et al.Pleural fluid tumour markers in malignant pleural effusion with inconclusive cytologic results[J].Curr Oncol,2015,22(5):e336-e341.
[17]祁明浩.胸腔积液间皮细胞计数对结核性、恶性胸腔积液的鉴别诊断分析[J].中国乡村医药杂志,2009,16(2):58.
[18]杨柯,张益辉,王泽球,等.胸水间皮细胞计数对良、恶性胸腔积液的鉴别诊断[J].临床肺科杂志,2006,11(3):341-342.
[19]巫天贤,金雪文.腺甘脱氨酶和间皮细胞计数在鉴别结核性与恶性胸水中的价值[J].温州医学院学报,2012,42(6):580-582.
[20]殷宗宝,谭元,陈彦凡,等.癌胚抗原和腺苷脱氨酶水平及间皮细胞计数对恶性与结核性胸腔积液的鉴别诊断价值[J].中国全科医学,2009,12(3B):450-452.
[21]刘颖,于素卿.血清和胸水CEA在结核性胸膜炎和恶性胸水患者中的表达及临床意义[J].包头医学,2016,40(1):13-14.
[22]Deeba F,Khatun S,Alam MM,et al.Serum LDH and CA-125:Markers for Diagnosis of Ovarian Malignancy[J].Mymensingh Med J,2015,24(2):334-340.
[23]陈晓菊,谢明智,裴思雅,等.胸腔积液肿瘤标记物检测的临床价值探讨[J].转化医学电子杂志,2017,4(5):40-43.