CAJ | 학술논문

目的以内科胸腔镜为金标准,评价结核性胸腔积液中腺苷脱氨酶(ADA)的浓度及其对结核性胸腔积液的诊断价值.方法连续入选2010年1月至2012年1月间在青岛大学医学院第二附属医院就诊并经内科胸腔镜检查确诊病因的胸腔积液患者102例,包括52例结核性胸腔积液和50例非结核性胸腔积液患者,比较两组胸腔积液中ADA浓度的差别,使用ROC法探索ADA最佳临界值并评价其诊断效能.结果 ①结核性胸腔积液组的ADA浓度高于非结核性胸腔积液组,分别为(40.3±9.3)U/L和(23.9±9.5)U/L,差异有统计学意义(P＜0.01)；②ROC曲线分析结果显示ADA可以很好地区分结核性胸腔积液和非结核性胸腔积液,采用Youden指数法确定34.5 U/L为鉴别结核性胸腔积液和非结核性胸腔积液的最佳临界值；③以胸腔镜检查为金标准,ADA＞34.5 U/L为诊断结核性胸腔积液指标,则敏感度为80.8％,特异度为90.0％,准确率为85.3％.结论与胸腔镜相比,胸腔积液ADA浓度是诊断结核性胸腔积液的重要指标,二者具有较高的一致性.
목적 이내과흉강경위금표준,평개결핵성흉강적액중선감탈안매(ADA)적농도급기대결핵성흉강적액적진단개치.방법 련속입선2010년1월지2012년1월간재청도대학의학원제이부속의원취진병경내과흉강경검사학진병인적흉강적액환자102례,포괄52례결핵성흉강적액화50례비결핵성흉강적액환자,비교량조흉강적액중ADA농도적차별,사용ROC법탐색ADA최가림계치병평개기진단효능.결과 ①결핵성흉강적액조적ADA농도고우비결핵성흉강적액조,분별위(40.3±9.3)U/L화(23.9±9.5)U/L,차이유통계학의의(P＜0.01)；②ROC곡선분석결과현시ADA가이흔호지구분결핵성흉강적액화비결핵성흉강적액,채용Youden지수법학정34.5 U/L위감별결핵성흉강적액화비결핵성흉강적액적최가림계치；③이흉강경검사위금표준,ADA＞34.5 U/L위진단결핵성흉강적액지표,칙민감도위80.8％,특이도위90.0％,준학솔위85.3％.결론 여흉강경상비,흉강적액ADA농도시진단결핵성흉강적액적중요지표,이자구유교고적일치성.
Objective To investigate the concentration of adenosine deaminase (ADA) and diagnostic value of ADA in tuberculous pleural effusions compared with thoracoscopy as gold standard.Methods 102 patients with pleural effusion definitely diagnosed by thoracoscopy including 52 tuberculous pleural effusion and 50 non-tuberculous pleural effusion were selected from January 2010 to January 2012.The concentration of ADA in the two groups was detected,the ROC method was used to explore the optimal threshold of ADA and evaluate the efficacy of the diagnosis.Results ① The concentration of ADA in tuberculous pleural effusion was higher than that in non-tuberculous pleural effusion [(40.3 ± 9.3) U/Lvs (23.9±9.5) U/L,P ＜0.01].②The result that was analyzed through the ROC curve showed that tuberculous pleural effusion and non-tuberculous pleural effusion were distinguished significantly by ADA,the best threshold of diagnosis of tuberculous pleural effusion was 34.5 U/L by the method of Youden index.③ Thoracoscopy was regarded as the gold standard and tuberculous pleural effusion was diagnosed if ADA was higher than 34.5 U/L,the sensitivity was 80.8％,the specificity was 90.0 ％,and the accuracy was 85.3 ％.Conclusions The concentration of ADA in the pleural effusion is an important indicator that can be used to diagnose tuberculous pleural effusion compared with thoracoscopy.