Toll样受体-2与腺苷脱氨酶测定对结核性胸水的诊断意义.pdf

广西ほ営2013年9月第35卷第9期
1121
l样受体2与腺苷脱氨酶测定对结核性胸水的诊断意义
黄陆颖巫艳彬2王武秦志强韦彩周
(1广西壮族自治区人民医院呼吸内科,南宁530021;2广西医科大学第一附属医院呼吸内科,南宁530021)
摘要】目的探讨胸腔积液中Tol样受体2(TLR-2)和腺苷脱酶(ADA)的水平对结核性胸腔釈液的
诊断价值。方法结核性胸腔积液35例,恶性胸腔积液31例,细茵性胸腔积液22例,用 ELISA法测定胸水上
清液和血清TLR2水平,比色法测定ADA水平。结果(1)结核组TLR2浓度为(23.21±2.17)ng/L,高于
恶性组(15.50士1.37)ng/L、细菌组(13.99±2.36)ng/L(P<0.05);恶性组、细菌组间比較差异无统计学意
义(P>0.05)。结核组及细菌组ADA水平均低于恶性组(P<0.05)。(2)受试者エ作特征曲线(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阙值为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对于诊断結核性胸腔积
液的曲线下面积、灵敏度、特异度、诊断値分别是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TR-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。
【关键词】结核性胸腔积液;Tl样受体2;腺苷脱氨酶
中图分类号】R521(文献标识码】A(文章编号)0253-4304(2013)09-1121-04
DOI:10.1675/j.issn.0253-4304.2013.09.02
Diagnostic Accuracy of Toll-like Receptor-2 and Adenosine Deaminase for Tuberculous Pleural Effusion
HUANG Lu-ying, WU Yan-bin, WANG Wu, IN Zhi-giang, WEI Cai-zhou
(1 Department of Respiatory Diseases, the Peoples Hopital of Gwangi Zhuang Autonomous Region, Nanning 530021, Chine
2 Stine of Reiay Diseases, he Fit Aliaed oa, Gn Meicad Anning 530021, Chin
Abstract Objective To investigate the diagnostic accuracy of pleural toll-like receptor-2(tlr-2)and a-
denosine deaminase(ADA )for tuberculous pleural effusion(TPE). Methods Pleural effusion samples were obtained
from 88 patien s(35 with TPE, 31 with malignant pleural effusion, 2 with aral pleural effusion).enzyme-linked
immunosorbent assay(ELISA )was used to detect the pleural effusion and serum levels of TLR-2, and colorimetry meth-
od was used to determine ADA activity. Results The concentration of TLR-2 in the TPE group[(2321 *2.17)
ng/L] was higher than that in the malignant group[(15.50 1 37)ng/L,], and that in the bacterial group[(13.99
2. 36)ng/](P<0.05) There was no significant difference in the concentration of TLR-2 between malignant
group and bacterial group(P>0. 05). The ADA levels in the TPE group and bacterial group were lower than that in
the malignant group(P<0.05). The receier operating characteristic curve showed that the cut-off value of pleural
TR-2 for the diagnosis of TP was 31. 15n/ with the corresponding sensitivity and specificity of 28. 13% and
97.90%, respectively, the area under curve(AUG)was 69.40%, 95 confidence nterval(CI): 57. 50%-81.30%
The cut-off value of pleural ADA for the diagnosis of TPE was 27. 50 U/L with the corresponding sensitivity and speci
ficity of 77.00% and 58.30%, respectively, the AUG was.80%,5%Ci: 46.80%-72.70%; The combination of
TLR-2 and ADA increased the specificity to 100 as well as increased the sensitivity to 84.40%. C
Pleural TR-2 or ADA may be help ul for the differential diagnosis of tuberculous pleural effusion. The combination of
TLR-2 and ADA may further improve the diagnostic accuracy.
Key words Tuberculous pleural effusion; Toll-like receptor-2; Ade
enosine deaminase
▲基金项目:广西自然科学基金(0728081);广西卫生厅科研立项课题(E2013394)