白介素27和腺苷脱氢酶单独及联合检测对结核性胸膜炎诊断价值

doi:10.3969/j.issn.1000-6621.2019.12.003

摘要/Abstract

摘要：

目的探讨白介素27((interleukin-27,IL-27)和腺苷脱氨酶(adenosine deaminase,ADA)单独检测及两者联合检测结果对结核性胸膜炎和恶性肿瘤所致胸腔积液的鉴别诊断价值。方法选取2017年12月1日至2018年7月29日福建省福州肺科医院收治的胸腔积液患者101例,通过闭式胸膜活检、内科胸腔镜检查获得病理学证据或者痰/胸腔积液分枝杆菌培养阳性及菌种鉴定结果。根据诊断结果分为结核性胸膜炎患者61例(结核组);恶性肿瘤所致胸腔积液患者40例(恶性组),其中肺黏膜相关淋巴瘤1例,恶性胸膜间皮瘤1例,肺黏液表皮样癌1例,非霍奇金淋巴瘤1例,小细胞肺癌3例,肺腺癌33例。采用酶联免疫吸附法检测两组患者胸腔积液中的IL-27和ADA的含量并进行统计学分析。应用受试者工作曲线(ROC)确定IL-27和ADA检测结果对鉴别结核性胸膜炎与恶性肿瘤所致胸腔积液的最佳临界值,并进一步分析IL-27与ADA联合检测(串联试验、并联试验)对于诊断结核性胸膜炎的价值。结果结核组患者胸腔积液中检测到的IL-27和ADA浓度分别为[409.48(229.04,954.97)]ng/L和(45.88±14.33)U/L,明显高于恶性组[分别为115.74(77.72,161.97)ng/L和10.50(7.00,15.00)U/L],差异均有统计学意义(Z=3.139,P<0.01;t=4.006,P<0.01)。绘制ROC曲线确定IL-27鉴别结核性胸腔积液与恶性胸腔积液诊断的最佳临界值为176.31ng/L,敏感度和特异度分别为85.25% (52/61)和82.50% (33/40);ADA鉴别结核性胸腔积液与恶性胸腔积液诊断的最佳临界值为28U/L,敏感度和特异度分别为93.44% (57/61)和87.50% (35/40)。串联试验方法联合检测,特异度(95.00%,38/40)较单独检测IL-27(82.50%,33/40)及单独检测ADA(87.50%,35/40)均明显升高,并有较好的敏感度(81.97%,50/61);并联试验方法联合检测,敏感度(96.72%,59/61)较单独检测IL-27(85.25%,52/61)及单独检测ADA(93.44%,57/61)均明显升高,但特异度较低(75.00%,30/40)。结论胸腔积液中IL-27和ADA对结核性胸膜炎的诊断均有较高价值;IL-27和ADA串联试验有助于结核性和恶性肿瘤所致胸腔积液的鉴别诊断。

关键词: 结核, 胸膜, 肿瘤, 胸腔积液, 诊断, 鉴别, 诊断技术和方法, 腺苷脱氨酶, 白细胞介素27

Abstract:

Objective To explore the value of diagnosis and differential diagnosis for tuberculous pleural effusion and malignant pleural effusion with human interleukin-27(IL-27) and adenosine deaminase (ADA) alone and in combination.Methods A total of 101 patients with pleural effusions admitted in Fuzhou Pulmonary Hospital of Fujian Province were enrolled during December 1, 2017 to July 29, 2018.All patients were diagnosed definitely by pathological evidenceobtained by closed pleural biopsy or medical thoracoscopy and bacteriological evidence obtained by culure from sputa or pleural effusion. According to the gold standard,they were divided into group of tuberculous pleural effusion in 61 cases (tuberculosis group) and group of malignant pleural effusion in 40 cases (as malignant pleural effusion group) including pulmonary mucosa-associated lymphoid tissue lymphoma,malignant pleural mesothelioma,pulmonary mueoepidermoid carcinoma,non-Hodgkin lymphomaand small cell lung carcinoma in each one case,and pulmonary adenocarcinoma in 33 cases. The levels of IL-27 and ADA from pleural effusion were detected by enzyme-linked immunosorbent assay (ELISA) and statistically analyzed. The cut-off values of IL-27 and ADA were determined for differential diagnosis between tuberculous and malignant pleural effusion using receiver operating characteristics (ROC) curve. IL-27 combined with ADA detection(series test,parallel test) was evaluated for diagnostic efficiency in diagnosis of tuberculous pleurisy.Results The concentrations of IL-27 and ADA in the tuberculous (409.48 (229.04, 954.97) ng/L and 45.88±14.33U/L) in the tuberculosis group were higher than those (115.74 (77.72, 161.97) ng/L and 10.50 (7.00, 15.00) U/L) in the malignant pleural effusion group with significant differences statistically (Z=3.139, P<0.01,t=4.006, P<0.01). By drawing ROC curve, The cut-off value of IL-27 and ADA from pleural effusion for distinguishing tuberculous pleural effusion from malignant pleural effusion were 176.31 ng/L and 28 U/L by drawing ROC curve.The sensitivity were 85.25% (52/61) and 93.44% (57/61) respectively, and the specificity were 82.50% (33/40) and 87.50% (35/40), respectively. The specificity (95.00%, 38/40) by series test was higher than that of IL-27 (82.50%, 33/40) and ADA (87.50%, 35/40) by alone test with a good sensitivity (81.97%,50/61). The sensitivity (96.72%, 59/61) by parallel test was higher than that of IL-27 (85.25%, 52/61) and ADA (93.44%, 57/61) by alone test. However, the specificity was low (75.00%,30/40).Conclusion IL-27 and ADA in pleural effusion have higher value in the diagnosis of tuberculous pleurisy, and the series test can improve the diagnostic efficiency for the differentiation between tuberculous pleurisy and malignant pleural effusions.

Key words: Tuberculosis, pleural, Neoplasms, Pleural effusion, Diagnosis, differential, Diagnostic techniques and procedures, Adenosine deaminase, Interleukin-27

吴迪,林友飞,陈晓红,沈建山,陈效友. 白介素27和腺苷脱氢酶单独及联合检测对结核性胸膜炎诊断价值[J]. 中国防痨杂志, 2019, 41(12): 1246-1251. doi: 10.3969/j.issn.1000-6621.2019.12.003

Di WU,You-fei LIN,Xiao-hong CHEN,Jian-shan SHEN,Xiao-you CHEN. Study on the diagnostic value of IL-27 and ADA alone and in combination in the tuberculous pleurisy[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1246-1251. doi: 10.3969/j.issn.1000-6621.2019.12.003

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组别	年龄 [岁, M(Q₁,Q₃)]	男		女
组别	年龄 [岁, M(Q₁,Q₃)]	例数	构成比(%)	例数	构成比(%)
结核组(61例)	45(25.00,66.00)	43	70.5	18	29.5
恶性组(40例)	64(55.25,73.75)	21	52.5	19	47.5
检验值	Z=-4.230	χ²=3.369
P值	<0.01	0.066

单独或联合检测胸腔积液	结核组 (61例)	恶性组 (40例)	敏感度 (%)	特异度 (%)	准确度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
IL-27			85.25	82.50	84.16	88.14	78.57	0.672
阳性	52	7
阴性	9	33
ADA			93.44	87.50	91.09	91.94	89.74	0.813
阳性	57	5
阴性	4	35
IL-27+ADA(并联试验)			96.72	75.00	88.12	85.51	93.75	0.743
阳性	59	10
阴性	2	30
IL-27+ADA(串联试验)			81.97	95.00	87.13	96.15	77.55	0.753
阳性	50	2
阴性	11	38