CAJ | 학술논문

　　目的探讨胸腔积液中Toll样受体-2（TLR-2）和腺苷脱氨酶（ADA）的水平对结核性胸腔积液的诊断价值。方法结核性胸腔积液35例，恶性胸腔积液31例，细菌性胸腔积液22例，用ELISA法测定胸水上清液和血清TLR-2水平，比色法测定ADA水平。结果（1）结核组TLR-2浓度为（23．21±2．17）ng/L，高于恶性组（15．50±1．37）ng/L、细菌组（13．99±2．36）ng/L（P＜0．05）；恶性组、细菌组间比较差异无统计学意义（P＞0．05）。结核组及细菌组ADA水平均低于恶性组（P＜0．05）。（2）受试者工作特征曲线（ROC曲线）结果显示：胸腔积液TLR-2浓度对于诊断结核性胸腔积液的最佳阈值为31．15ng/L、曲线下面积（AUC）为69．40％（95％CI：57．50％～81．30％），灵敏度和特异度分别为28．13％、97．90％；ADA对于诊断结核性胸腔积液的曲线下面积、灵敏度、特异度、诊断阈值分别是59．80％（95％CI：46．80％～72．70％）、77．00％、58．30％和27．50U/L；同时检测 TLR-2和 ADA的诊断特异度为100％；联合检测 TLR-2和 ADA的诊断灵敏度为84．40％。结论单独测定TLR-2及ADA均有助于诊断结核性胸腔积液，联合指测更能提高诊断效能。
　　목적탐토흉강적액중Toll양수체-2（TLR-2）화선감탈안매（ADA）적수평대결핵성흉강적액적진단개치。방법결핵성흉강적액35례，악성흉강적액31례，세균성흉강적액22례，용ELISA법측정흉수상청액화혈청TLR-2수평，비색법측정ADA수평。결과（1）결핵조TLR-2농도위（23．21±2．17）ng/L，고우악성조（15．50±1．37）ng/L、세균조（13．99±2．36）ng/L（P＜0．05）；악성조、세균조간비교차이무통계학의의（P＞0．05）。결핵조급세균조ADA수평균저우악성조（P＜0．05）。（2）수시자공작특정곡선（ROC곡선）결과현시：흉강적액TLR-2농도대우진단결핵성흉강적액적최가역치위31．15ng/L、곡선하면적（AUC）위69．40％（95％CI：57．50％～81．30％），령민도화특이도분별위28．13％、97．90％；ADA대우진단결핵성흉강적액적곡선하면적、령민도、특이도、진단역치분별시59．80％（95％CI：46．80％～72．70％）、77．00％、58．30％화27．50U/L；동시검측 TLR-2화 ADA적진단특이도위100％；연합검측 TLR-2화 ADA적진단령민도위84．40％。결론단독측정TLR-2급ADA균유조우진단결핵성흉강적액，연합지측경능제고진단효능。
Objective Toinvestigatethediagnosticaccuracyofpleuraltoll-likereceptor-2(TLR-2)anda-denosinedeaminase(ADA)fortuberculouspleuraleffusion(TPE).MethodsPleuraleffusionsampleswereobtained from88patients(35withTPE,31withmalignantpleuraleffusion,22withbacterialpleuraleffusion).Enzyme-linked immunosorbentassay(ELISA)wasusedtodetectthepleuraleffusionandserumlevelsofTLR-2,andcolorimetrymeth-odwasusedtodetermineADAactivity.Results ①TheconcentrationofTLR-2intheTPEgroup[(23.21 ±2.17) ng/L]washigherthanthatinthemalignantgroup[(15.50 ±1.37)ng/L],andthatinthebacterialgroup[(13.99 ± 2.36)ng/L](P<0.05);TherewasnosignificantdifferenceintheconcentrationofTLR-2betweenmalignant groupandbacterialgroup(P>0.05).TheADAlevelsintheTPEgroupandbacterialgroupwerelowerthanthatin themalignantgroup(P<0.05).②Thereceiveroperatingcharacteristiccurveshowedthatthecut-offvalueofpleural TLR-2forthediagnosisofTPE was31.15ng/Lwiththecorrespondingsensitivityandspecificityof28.13% and 97.90%,respectively,theareaundercurve(AUG)was69.40%,95% confidenceinterval(CI):57.50%-81.30%;Thecut-offvalueofpleuralADAforthediagnosisofTPEwas27.50U/Lwiththecorrespondingsensitivityandspeci-ficityof77.00% and58.30%,respectively,theAUGwas59.80%,95%CI:46.80%-72.70%;Thecombinationof TLR-2andADA increasedthespecificityto100% aswellasincreasedthesensitivityto84.40%.Conclusion PleuralTLR-2orADAmaybehelpfulforthedifferentialdiagnosisoftuberculouspleuraleffusion.Thecombinationof TLR-2andADAmayfurtherimprovethediagnosticaccuracy.