胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨.docVIP

胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨 罗虎，宫亮，周向东? ? 通讯作者，TelEmail：xiangdongzhou@126.com. （重庆第三军医大学西南医院呼吸内科 400038） 摘要： 目的 探讨腺苷脱氨酶（ADA）在鉴别结核性胸腔积液及恶性胸腔积液中的价值，进而分析性别、年龄对结核性胸腔积液ADA值的影响，探讨诊断“结核性胸膜炎”的最佳ADA临界值。方法 对分别确诊为“结核性胸腔积液”和“恶性胸腔积液”共305例患者的胸腔积液ADA值及其影响因素（性别、年龄）进行回顾性分析，利用ROC曲线探讨胸腔积液ADA诊断结核性胸膜炎的最佳临界值。结果 结核性胸腔积液ADA活性为（42.68±15.69）IU/L，而恶性胸腔积液为（12.69±8.75）IU/L，两者差异具有显著统计学意义（P0.01）；而不同性别和不同年龄段的结核性胸腔积液ADA活性之间没有统计学差异（P0.05）；将ADA值设定为23.3 IU/L时，其诊断结核性胸膜炎的灵敏度和特异度分别为94.8%和92.8%。结论 胸腔积液ADA值可以作为鉴别结核性胸腔积液与恶性胸腔积液的重要指标，且将ADA值设定为23.3 IU/L时，其诊断结核性胸膜炎的灵敏度和特异度分别为94.8%和92.8%。 关键词：胸腔积液，结核性胸膜炎，腺苷酸脱氢酶（ADA），影响因素，临界值 中图分类号：R521.7 The Diagnosis Utility of ADA activity in Tuberculous Pleurisy and investigation of its Threshold Luo Hu, Gong Liang, Zhou Xiangdong (Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, 400038, China Abstract: Objective To investigate: 1)the ADA value in differential diagnosis of hydrothorax;2)the factors involved in ADA value of tuberculous pleurisy ;3)the critical value of ADA for the diagnosis of tuberculous pleurisy.Methods A retrospective analysis was performed with ADA values in 136 cases of tuberculous pleurisy and 169 cases of malignant hydrothorax. The critical value of ADA was determined by ROC curve. Results The activity of ADA is（42.68±15.69）IU/L in tuberculous hydrothorax ,which was higher than（12.69±8.75）IU/L in malignant hydrothorax with statistical difference(P0.01).But the activity of ADA in groups of different gender and age did not have significant difference(P0.05) .The critical value of ADA was 23.3 IU/L in diagnosis of tuberculous pleurisy, its corresponding sensitivity and specificity were 94.8% and 92.8%, respectively. Conclusion The activity of ADA could be wildly used in the differential diagnosis of tuberculous and malignant hydrothorax. It can be used to diagnosis tuberculous pleurisy when the ADA value in hydrothorax is more than 23.3 IU/L, and the sensitivity and specificity can rea