多指标联合检测对结核性与肺癌性胸腔积液的鉴别诊断价值
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摘要
目的评估胸腔积液中的白细胞数(WBC)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、癌胚抗原(P-CEA)和血清中的铁蛋白(FRT)、糖类抗原CA50、糖类抗原CA125、癌胚抗原(S-CEA)以及全血结核感染T细胞斑点试验(TSPOT.TB)在鉴别结核性胸腔积液(tuberculous pleural effusion,TPE)与肺癌性胸腔积液(malignant pleural effusion of lung cancer,LC-MPE)中的应用价值,以期筛选最优的鉴别诊断模型。方法选取临床确诊的82例TPE患者和120例LC-MPE患者的胸腔积液和血液进行上述指标的检测并用ROC曲线分析以确定单项检测以及联合检测的诊断性能。结果 LC-MPE组的P-CEA、CA50、CA125和S-CEA水平均高于TPE组(P<0.05),TPE组的WBC、ADA和T-SPOT.TB水平均高于LC-MPE组(P<0.05);ROC曲线表明:ADA、P-CEA、S-CEA和T-SPOT.TB水平对TPE和LC-MPE的鉴别诊断均具有一定的价值;多指标联合分析提示:ADA和P-CEA联合模式(AUC=0.980)与ADA、P-CEA、S-CEA和T-SPOT.TB四项指标联合模式(AUC=0.988)具有更高的诊断价值。结论 ADA、P-CEA、S-CEA和T-SPOT.TB表达水平对TPE和LC-MPE的鉴别诊断均具有一定的价值;而ADA和P-CEA联合模式与ADA、P-CEA、S-CEA和T-SPOT.TB联合模式可作为鉴别两种疾病较好的诊断模型。
Objective To assesse the clinical diagnostic value of pleural effusion WBC,lactate dehydrogenase(LDH),adenosine deaminase(ADA),carcinoembryonic antigen(P-CEA)combined with serum ferritin(FRT),carbohydrate antigen 50(CA50),carbohydrate antigen 125(CA125),carcinoembryonic antigen(S-CEA)and T cell spot test of TB infection(T-SPOT.TB)in distinguishing tuberculous pleural effusion(TPE)and malignant pleural effusion of lung cancer(LC-MPE)and acquire the optimal diagnostic model.Methods To selecte 82 patients of TPE and 120 patients of LC-MPE in this study.The levels of those indexes in the pleural effusion and serum were detected and analyzed by ROC curves to confirm the Diagnostic performance of single and conbined indexes.Results The levels of P-CEA,CA50,CA125 and S-CEA in LC-MPE were significantly higher than TPE(P<0.05).The levels of WBC,ADA and T-SPOT.TB in TPE were significantly higher than LC-MPE(P<0.05);It was suggested by ROC curves that there were diagnostic value of ADA,P-CEA,S-CEA and T-SPOT.TB for distinguishing TPE and LC-MPE;Multi-factor analysis showed that the combined detection model of indicators of ADA and P-CEA(AUC=0.980)and ADA,P-CEA,S-CEA and T-SPOT.TB(AUC=0.988)were better than alone and other combined detection models.Conclusion The expression levels of ADA,P-CEA,S-CEA and T-SPOT.TB all have certain value in distinguishing TPE and LC-MPE,whereas the diagnostic efficacy of combined model of ADA,P-CEA,S-CEA and T-SPOT.TB was superior to other diagnostic models.
Objective To assesse the clinical diagnostic value of pleural effusion WBC,lactate dehydrogenase(LDH),adenosine deaminase(ADA),carcinoembryonic antigen(P-CEA)combined with serum ferritin(FRT),carbohydrate antigen 50(CA50),carbohydrate antigen 125(CA125),carcinoembryonic antigen(S-CEA)and T cell spot test of TB infection(T-SPOT.TB)in distinguishing tuberculous pleural effusion(TPE)and malignant pleural effusion of lung cancer(LC-MPE)and acquire the optimal diagnostic model.Methods To selecte 82 patients of TPE and 120 patients of LC-MPE in this study.The levels of those indexes in the pleural effusion and serum were detected and analyzed by ROC curves to confirm the Diagnostic performance of single and conbined indexes.Results The levels of P-CEA,CA50,CA125 and S-CEA in LC-MPE were significantly higher than TPE(P<0.05).The levels of WBC,ADA and T-SPOT.TB in TPE were significantly higher than LC-MPE(P<0.05);It was suggested by ROC curves that there were diagnostic value of ADA,P-CEA,S-CEA and T-SPOT.TB for distinguishing TPE and LC-MPE;Multi-factor analysis showed that the combined detection model of indicators of ADA and P-CEA(AUC=0.980)and ADA,P-CEA,S-CEA and T-SPOT.TB(AUC=0.988)were better than alone and other combined detection models.Conclusion The expression levels of ADA,P-CEA,S-CEA and T-SPOT.TB all have certain value in distinguishing TPE and LC-MPE,whereas the diagnostic efficacy of combined model of ADA,P-CEA,S-CEA and T-SPOT.TB was superior to other diagnostic models.
引文
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[19]Son S M,Han H S,An J Y,et al.Diagnostic performance of CD66cin lung adenocarcinoma-associated malignant pleural effusion:comparison with CEA,CA 19-9,and CYFRA 21-1[J].Pathology,2015,47(2):123.
[20]Ji M,Li X D,Shi H B,et al.Clinical significance of serum ferritin in elderly patients with primary lung carcinoma[J].Tumour Biol,2014,35(10):10195.
[21]Ludwig H,Muldur E,Endler G,et al.Prevalence of iron deficiency across different tumors and its association with poor performance status,disease status and anemia[J].Ann Oncol,2013,24(7):1886.
[22]Yan G Y,Xu Z Y,Deng H B,et al.[Effects of chemotherapy combined with Chinese herbal medicine Kangliu Zengxiao decoction on tumor markers of patients with advanced non-small-cell lung cancer:a randomized,controlled trial][J].Zhong Xi Yi Jie He Xue Bao,2011,9(5):525.
[23]Lu D,Chen C,Yu S,et al.Diagnosis of Tuberculous Meningitis Using a Combination of Peripheral Blood T-SPOT.TB and Cerebrospinal Fluid Interferon-gamma Detection Methods[J].Lab Med,2016,47(1):6.
[24]Gao L,Lu W,Bai L,et al.Latent tuberculosis infection in rural China:baseline results of a population-based,multicentre,prospective cohort study[J].Lancet Infect Dis,2015,15(3):310.
[25]Pan L,Liu F,Zhang J,et al.Interferon-Gamma Release Assay Performance of Cerebrospinal Fluid and Peripheral Blood in Tuberculous Meningitis in China[J].Biomed Res Int,2017,2017:8198505.
[26]Cho K,Cho E,Kwon S,et al.Factors Associated with Indeterminate and False Negative Results of QuantiFERON-TB Gold InTube Test in Active Tuberculosis[J].Tuberc Respir Dis(Seoul),2012,72(5):416.
[27]Jeon Y L,Nam Y S,You E,et al.Factors influencing discordant results of the QuantiFERON-TB Gold In-tube test in patients with active TB[J].J Infect,2013,67(4):288.
[2]Liu Y,Ou Q,Zheng J,et al.A combination of the QuantiFERONTB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion[J].Emerg Microbes Infect,2016,5(8):e83.
[3]Siegel R L,Miller K D,Jemal A.Cancer statistics,2016[J].CA Cancer J Clin,2016,66(1):7.
[4]Lama A,Ferreiro L,Golpe A,et al.Characteristics of Patients with Lymphangioleiomyomatosis and Pleural Effusion:A Systematic Review[J].Respiration,2016,91(3):256.
[5]胡建林,杨和平.呼吸疾病鉴别诊断与治疗学[M].第2版.北京:人民军医出版社,2015:379.
[6]胡建林,杨和平.呼吸疾病鉴别诊断与治疗学[M].第2版.北京:人民军医出版社,2015:400.
[7]Assawasaksakul T,Boonsarngsuk V,Incharoen P.A comparative study of conventional cytology and cell block method in the diagnosis of pleural effusion[J].J Thorac Dis,2017,9(9):3161.
[8]Liu Y,Ou Q,Zheng J,et al.A combination of the QuantiFERONTB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion[J].Emerg Microbes Infect,2016,5(8):e83.
[9]Sahu K K,Tyagi R,Law A D,et al.Myeloid Sarcoma:An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature[J].Indian J Hematol Blood Transfus,2015,31(4):466.
[10]陈汉才,胡余敏,葛建军,等.胸水腺苷脱氨酶和乳酸脱氢酶水平检测对感染性胸腔积液的诊断价值分析[J].中华医院感染学杂志,2018,5:695.
[11]张倩云.胸水腺苷脱氨酶乳酸脱氢酶癌胚抗原对结核性胸膜炎和癌性胸腔积液的鉴别诊断价值探讨[J].河北医学,2015,4:576.
[12]Samanta S,Sharma A,Das B,et al.Significance of Total Protein,Albumin,Globulin,Serum Effusion Albumin Gradient and LDH in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis and Cancer[J].J Clin Diagn Res,2016,10(8):C14.
[13]Zhang F,Wang J,Zheng X,et al.Clinical value of jointly detection pleural fluid Midkine,pleural fluid adenosine deaminase,and pleural fluid carbohydrate antigen 125in the identification of nonsmall cell lung cancer-associated malignant pleural effusion[J].J Clin Lab Anal,2018:e22576.
[14]Assawasaksakul T,Boonsarngsuk V,Incharoen P.A comparative study of conventional cytology and cell block method in the diagnosis of pleural effusion[J].J Thorac Dis,2017,9(9):3161.
[15]Servonnet A,Frederic C,Fargeau F,et al.Pleural adenosine deaminase cut-off value for the diagnosis of tuberculous pleural effusion using the Diazyme assay[J].Hong Kong Med J,2018,24(2):207.
[16]Tay T R,Tee A.Factors affecting pleural fluid adenosine deaminase level and the implication on the diagnosis of tuberculous pleural effusion:a retrospective cohort study[J].BMC Infect Dis,2013,13:546.
[17]Hernandez L,Espasa A,Fernandez C,et al.CEA and CA 549in serum and pleural fluid of patients with pleural effusion[J].Lung Cancer,2002,36(1):83.
[18]Radjenovic-Petkovic T,Pejcic T,Nastasijevic-Borovac D,et al.Diagnostic value of CEA in pleural fluid for differential diagnosis of benign and malign pleural effusion[J].Med Arh,2009,63(3):141.
[19]Son S M,Han H S,An J Y,et al.Diagnostic performance of CD66cin lung adenocarcinoma-associated malignant pleural effusion:comparison with CEA,CA 19-9,and CYFRA 21-1[J].Pathology,2015,47(2):123.
[20]Ji M,Li X D,Shi H B,et al.Clinical significance of serum ferritin in elderly patients with primary lung carcinoma[J].Tumour Biol,2014,35(10):10195.
[21]Ludwig H,Muldur E,Endler G,et al.Prevalence of iron deficiency across different tumors and its association with poor performance status,disease status and anemia[J].Ann Oncol,2013,24(7):1886.
[22]Yan G Y,Xu Z Y,Deng H B,et al.[Effects of chemotherapy combined with Chinese herbal medicine Kangliu Zengxiao decoction on tumor markers of patients with advanced non-small-cell lung cancer:a randomized,controlled trial][J].Zhong Xi Yi Jie He Xue Bao,2011,9(5):525.
[23]Lu D,Chen C,Yu S,et al.Diagnosis of Tuberculous Meningitis Using a Combination of Peripheral Blood T-SPOT.TB and Cerebrospinal Fluid Interferon-gamma Detection Methods[J].Lab Med,2016,47(1):6.
[24]Gao L,Lu W,Bai L,et al.Latent tuberculosis infection in rural China:baseline results of a population-based,multicentre,prospective cohort study[J].Lancet Infect Dis,2015,15(3):310.
[25]Pan L,Liu F,Zhang J,et al.Interferon-Gamma Release Assay Performance of Cerebrospinal Fluid and Peripheral Blood in Tuberculous Meningitis in China[J].Biomed Res Int,2017,2017:8198505.
[26]Cho K,Cho E,Kwon S,et al.Factors Associated with Indeterminate and False Negative Results of QuantiFERON-TB Gold InTube Test in Active Tuberculosis[J].Tuberc Respir Dis(Seoul),2012,72(5):416.
[27]Jeon Y L,Nam Y S,You E,et al.Factors influencing discordant results of the QuantiFERON-TB Gold In-tube test in patients with active TB[J].J Infect,2013,67(4):288.