CAJ | 학술논문

目的：检测胸腔积液中腺苷脱氨酶（ADA）和乳酸脱氢酶（LDH）的水平，探讨二者联合检测鉴别诊断结核性和淋巴瘤性胸腔积液的临床价值研究。方法采用酶联免疫法检测455例临床和病理已确诊的各种良恶性胸腔积液患者胸腔积液中ADA和LDH的含量，分析联合检测ADA和LDH诊断结核性、非结核性、淋巴瘤性和非淋巴瘤性胸腔积液的敏感度、特异度、阳性预测值和阴性预测值。结果结核性胸腔积液中的ADA含量明显高于非结核性良性胸腔积液和非淋巴瘤性恶性胸腔积液，而淋巴瘤性胸腔积液中的ADA含量明显高于结核性胸腔积液，差异均具有统计学意义（P<0.05）。所有恶性胸腔积液中的LDH含量均显著高于良性胸腔积液，差异均具有统计学意义（P<0.05）。ADA≥40 U·L-1联合LDH<500 U·L-1诊断结核性胸腔积液的敏感度为85.5％，特异度为94.0％；而ADA≥40 U·L-1联合LDH≥500 U·L-1诊断淋巴瘤性胸腔积液的敏感度为86.4％，特异度为96.3％。结论胸腔积液中ADA和LDH含量联合检测有助于鉴别诊断结核性胸腔积液和淋巴瘤性胸腔积液。
목적：검측흉강적액중선감탈안매（ADA）화유산탈경매（LDH）적수평，탐토이자연합검측감별진단결핵성화림파류성흉강적액적림상개치연구。방법채용매련면역법검측455례림상화병리이학진적각충량악성흉강적액환자흉강적액중ADA화LDH적함량，분석연합검측ADA화LDH진단결핵성、비결핵성、림파류성화비림파류성흉강적액적민감도、특이도、양성예측치화음성예측치。결과결핵성흉강적액중적ADA함량명현고우비결핵성량성흉강적액화비림파류성악성흉강적액，이림파류성흉강적액중적ADA함량명현고우결핵성흉강적액，차이균구유통계학의의（P<0.05）。소유악성흉강적액중적LDH함량균현저고우량성흉강적액，차이균구유통계학의의（P<0.05）。ADA≥40 U·L-1연합LDH<500 U·L-1진단결핵성흉강적액적민감도위85.5％，특이도위94.0％；이ADA≥40 U·L-1연합LDH≥500 U·L-1진단림파류성흉강적액적민감도위86.4％，특이도위96.3％。결론흉강적액중ADA화LDH함량연합검측유조우감별진단결핵성흉강적액화림파류성흉강적액。
Objective To investigate the significance of the combination detection of the level of adenosine deaminase(ADA) and lactate dehydrogenase(LDH) in pleural effusion in diagnosing tuberculous or lymphoma malignant pleural effusion. Methods The levels of ADA and LDH in pleural effusion were measured via Enzyme-linked immunoassay in 455 patients who were confirmed clinically and pathologically with various benign or malignant pleural effusion. The sensitivity, specificity, positive and negative predictive value of the combined detec-tion of ADA and LDH were respectively analyzed in diagnosing tuberculous or non-tuberculous, lymphoma or non-lymphoma pleural effu-sion. Results The ADA levels in patients with tuberculous pleural effusion (TPE) were statistically higher than in those with non-tuberculous benign pleural effusion (non-TPE) or with non-lymphoma malignant pleural effusion (non-LPE), but significantly lower than in patients with lymphoma pleural effusion (LPE) (P<0.05). The LDH levels were higher in patients with malignant pleural effusion than in those with be-nign pleural effusion (P<0.05). The sensitivity and specificity was respectively 85.5%and 94.0%respectively with the combination of ADA level no 1ess than 40 U·L-1 and LDH level less than 500 U·L-1 in the diagnosis of TPE. While in the diagnosis of LPE, the sensitivity and specificity was respectively 86.4%and 96.3%with the combination of ADA level no 1ess than 40 U·L-1 and LDH level no less than 500 U·L-1. Conclusions The ADA and LDH levels in pleural effusion is clinically helpful to identify the character of effusion. This index combination may improve the accuracy for the diagnosis of TPE and LPE.