华西医学

华西医学

结核性胸腔积液和恶性胸腔积液患者的临床特征及实验室指标的诊断效能研究

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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。

ObjectiveTo 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.MethodsThe 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.ResultsThe 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.ConclusionsThe 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.

关键词: 结核性胸腔积液; 恶性胸腔积液; 实验指标; 诊断效能

Key words: Tuberculous pleural effusion; Malignant pleural effusion; Laboratory indexes; Diagnostic efficacy

引用本文: 黄燕春, 巫丽娟, 丁柳, 陆小军, 刘堂喻亨, 应斌武. 结核性胸腔积液和恶性胸腔积液患者的临床特征及实验室指标的诊断效能研究. 华西医学, 2018, 33(8): 966-971. doi: 10.7507/1002-0179.201807065 复制

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