胸腔积液和血清学指标联合检测对不同性质胸腔积液的诊断价值

目的 探讨联合检测胸腔积液及血清各项指标对结核性、癌性及非特异炎性胸腔积液的诊断价值.方法 回顾性分析符合本研究纳入标准的408例完整病历资料,其中200例结核性胸腔积液患者为结核组,64例恶性胸腔积液患者为癌性组,144例类肺炎性胸腔积液为炎性组.分析病例的一般临床特征,收集3组患者的相关指标,建立多元线性回归模型.结果 结核性胸腔积液多见于50岁以下的中青年人群(76.00％),女性多于男性(男女性别比为0.56∶1),196例患者(98.00％)存在胸痛表现;癌性和炎性胸腔积液多见于50岁以上中老年人群(75.00％和72.22％),男性多于女性(1.67∶1和1.77∶1),仅24例癌性胸腔积液患者(37.50％)和24例炎性胸水患者(16.67％)表现为胸痛.3组间比较,炎性组血清降钙素原(PCT)显著增高,癌性组胸水癌胚抗原(CEA)及乳酸脱氢酶(LDH)显著增高,结核组血清红细胞沉降率(ESR)及胸腔积液腺苷脱氨酶(ADA)显著增高,且差异均有统计学意义(F=5.327、21.442、10.497、4.687和7.562,P均＜0.05).多元线性回归分析显示,胸腔积液ADA、CEA及血清PCT对结核性胸腔积液有诊断意义(t=3.595、-2.267和-2.164,P均＜0.05);胸腔积液CEA、LDH、ADA对癌性胸腔积液有诊断意义(t=7.258、5.464和-4.119,P均＜0.01);血清PCT、胸腔积液LDH及CEA对炎性胸积液有诊断意义(t=3.388、-4.624和-2.164,P均＜0.01).结论 血清PCT及胸腔积液CEA升高有助于排除结核性胸积液;高水平胸腔积液CEA、LDH及低水平胸水ADA有助于癌性积液的诊断;高水平胸腔积液CEA及低水平胸腔积液LDH、CEA有助于炎性积液的诊断.

Application of pleural fluid combined with serum indicators in the diagnosis of various types of pleural effusion

Objective To explore the clinical value of pleural fluid combined with serum indicators for the diagnosis of tuberculous,malignant and nonspecific inflammatory pleural.Methods The complete medical records of 408 cases enrolled in this research were analyzed.Patients were divided into tuberculous pleural effusion group (tuberculosis group,n=200),malignant pleural effusion group (carcinoma group,n=64) and parapneumonia pleural effusion group(inflammatory group,n=144).The general clinical characteristics and related indicators of patients were analyzed,and multiple linear regression model was established.Results The tuberculous pleural effusion was mainly seen in the people under 50 years old (76.00％) with more females than males (0.56 ∶ 1).There were 196 patients (98.00％) with chest pain in tuberculosis group.The malignant and inflammatory pleural effusion were mainly seen in the people over 50 years old (75.00％ and 72.22％) with more males than females (1.67 ∶ 1 and 1∶77 ∶ 1).There were only 24 patients (37.50％) in carcinoma group and 24 patients (16.67％) in inflammatory group with chest pain.Among 3 groups,the serum procalitonin (PCT) increased obviously in inflammatory group,the pleural effusion carcinoembr yonicantigen (CEA) and lactate dehydrogenase (LDH) increased obviously in carcinoma group,and the serum erythrocyte sedimentation rate (ESR) and pleural effusion adenosine deaminase (ADA) increased obviously in tuberculosis group.Their differences had statistical significances (F=5.327,21.442,10.497,4.687 and 7.562,P all＜ 0.05).Multiple linear regression analysis indicated that pleural effusion ADA,CEA and serum PCT had diagnostic value to tuberculosis pleural fluid (t=3.595,-2.267 and-2.164,Pall ＜0.05);pleural effusion CEA,LDH and ADA had diagnostic value to malignant pleural effusion (t =7.258,5.464 and-4.119,P all ＜0.01);serum PCT,pleural effusion LDH and CEA had diagnostic value to inflammatory pleural effusion(t=3.388,-4.624 and-2.164,Pall＜0.01).Conclusions The increase of serum PCT and pleural effusion CEA is helpful to eliminate tuberculous pleural fluid.High levels of pleural effusion CEA,LDH and low level of pleural effusion ADA are helpful to diagnose malignant pleural fluid.High level of pleural effusion CEA and low levels of pleural effusion LDH and CEA are helpful to diagnose inflammatory pleural fluid.