摘要
目的分析结核性胸腔积液患者和恶性胸腔积液患者的临床特征,探讨胸水实验室指标在结核性胸腔积液和恶性胸腔积液鉴别诊断中的价值。方法收集2017年1月—12月四川大学华西医院结核性胸腔积液和恶性胸腔积液患者的临床资料及胸水实验室指标,筛选出具有统计学差异的实验室指标,采用logistic回归分析建立实验室指标联合诊断模型,用Hosmer-Lemeshow检验模型的拟合度,绘制联合诊断的受试者工作特征(receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(area under curve,AUC),分析联合诊断效能。结果 128例结核性胸腔积液患者和164例恶性胸腔积液患者的平均年龄分别为(51.60±21.02)、(63.52±11.87)岁,结核性胸腔积液患者易出现咳嗽、咳痰、发热、胸痛、气紧症状,两组间比较差异有统计学意义(P<0.05)。结核性胸腔积液患者胸水中的腺苷脱氨酶水平为(23.06±21.29)U/L,比恶性胸腔积液患者高(P<0.05)。恶性胸腔积液患者胸水中的白蛋白、葡萄糖、糖类抗原(carbohydrate antigen,CA)125、CA19-9、癌胚抗原和细胞角蛋白19片段抗原水平高于结核性胸腔积液患者(P<0.05)。logistic回归分析发现,CA125、癌胚抗原和葡萄糖作为主效应被纳入模型中,利用预测值绘制ROC曲线,AUC为0.914[95%置信区间(0.864,0.964)],提高了诊断效能。结论结核性胸腔积液和恶性胸腔积液患者临床表现多样化且特异性不高,联合检测胸水中的CA125、癌胚抗原和葡萄糖,并利用其建立联合诊断模型,可较好地鉴别结核性胸腔积液和恶性胸腔积液。
Objective To analyze the clinical characteristics of patients with tuberculous pleural effusion and malignant pleural effusion and explore the value of laboratory indexes of pleural effusion in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion. Methods The clinical data and laboratory indexes of pleural effusion of patients with tuberculous pleural effusion and patients with malignant pleural effusion hospitalized in West China Hospital of Sichuan University between January and December 2017 were analyzed retrospectively. Those examinations with statistical significance were selected to establish a binary logistic regression model for diagnosing malignant pleural effusion from tuberculous pleural effusion. Hosmer-Lemeshow test was used to assess the goodness of fit of the logistic model, and a receiver operating characteristic（ROC） curve was plotted to assess the diagnostic value of the model. Results The average age of the 128 patients with tuberculous pleural effusion was（51.60±21.02） years, and the average age of the 164 malignant pleural effusion was（63.52±11.87） years. Patients with tuberculous pleural effusion were prone to getting symptoms of cough, expectoration, fever, chest pain and tightness in breathing, with statistical significance（P〈0.05）. The level of adenosine deaminase in patients with tuberculous pleural effusion was（23.06±21.29）U/L, higher than that in malignant pleural effusion; the difference was statistically significant（P〈0.05）. The levels of albumin, glucose, carbohydrate antigen（CA） 125, CA19-9, carcinoembryonic antigen（CEA） and cyto-keratin 19 fragment antigen 21-1 in patients with malignant pleural effusion were higher than those in patients with tuberculous pleural effusion（P〈0.05）. Logistic regression analysis showed that CA125, CEA and glucose were introduced to model as the main effect. The area under the ROC curve was 0.914 [95% confidence interval（0.864, 0.964）], with an improved diagnostic efficiency. Conclusions The clinical manifestations of tuberculous pleural effusion and malignant pleural effusion are multifarious with low specificity. A joint detection of CA125, CEA and glucose in pleural effusion and the joint diagnostic model can identify tuberculous pleural effusion and malignant pleural effusion better.
作者
黄燕春
巫丽娟
丁柳
陆小军
刘堂喻亨
应斌武
HUANG Yanchun;WU Lijuan;DING Liu;LU Xiaojun;LIU Tangyuheng;YING Binwu(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)
出处
《华西医学》
CAS
2018年第8期966-971,共6页
West China Medical Journal
基金
国家自然科学基金(81472026
81672095)
国家科技重大专项艾滋病和病毒性肝炎等重大传染病防治项目(2012ZX10004-901)
四川省卫生和计划生育委员会基金项目(16ZD004)
关键词
结核性胸腔积液
恶性胸腔积液
实验指标
诊断效能
Tuberculous pleural effusion
Malignant pleural effusion
Laboratory indexes
Diagnostic efficacy
