D-二聚体、CEA及ADA联合检测在结核性与恶性胸腔积液鉴别诊断中的价值

目的：探讨联合检测D-二聚体（DD）、癌胚抗原（CEA）、腺苷脱胺酶（ADA）对胸腔积液性质判断的临床价值。方法：分别采用乳胶免疫比浊法、化学发光免疫法、比色法测量临床确诊的80例结核性胸腔积液和120例恶性胸腔积液患者胸水中D-二聚体、CEA及ADA含量。结果：结核性胸腔积液组D-二聚体、ADA水平显著高于恶性胸腔积液组，而CEA水平明显低于恶性胸腔积液组。结核性胸腔积液中，D-二聚体诊断的灵敏度为72．5％，特异度为61．1％；CEA诊断的灵敏度为22．2％，特异度为13．9％；ADA诊断的灵敏度为64％，特异度为75％。三者联合诊断的灵敏度为97．5％，特异度为91．7％。结论：联合检测D-二聚体、CEA、ADA有助于良恶性胸腔积液的鉴别诊断，有效减少漏诊及误诊。

The diagnostic value of D-dimer,CEA and ADA combined examination in distinguishing tuberculous pleural effusion from malignant one

Objective ： To assess the differential diagnostic value of combined detection of D-dimer, CEA, ADA in tuberculous, malignant pleural effusion. Methods ： D-dimer, CEA, ADA were measured in 30 patients with tuberculous pleural effusion and 120 patients patients with malignant pleural effusion. D-dimer levels were determined by latex immune turbidimetry, CEA levels were determined by chemiluminescence immunoassay, ADA levels were determined by colorimetric method.Results ： The contents of D-dimer and ADA in tuberculous pleura1 effusion are significantly higher than that in malignant pleura1 effusion, while the content of CEA is low. The sensitivity and specificity of diagnosing the tuberculous pleural effusion using D-dimer were 72.5%, 61.1%; CEA were 22.2%, 13.9% ; ADA were 64%, 75% respectively. What＇ s more, the sensitivity and specificity of diagnosing the tuberculous pleural effusion by combined detection the level of D-dimer, CEA, ADA can up to 97.5%, 91.7% respectively. Conclusions ： Combined detection the level of D-dimer, CEA, ADA have certain clinical value for differentiating tuberculous, malignant pleural effusion, which can reduce missed diagnosis and misdiagnosis effectively.