| 摘要: |
| 目的 评价血清乳酸脱氢酶（LDH）、胸腔积液腺苷脱氨酶（ADA）及其比值在恶性胸腔积液（MPE）中的诊断价值。方法 采用回顾性分析方法，选取2019年11月至2022年8月195例渗出性胸腔积液患者作为研究对象，其中MPE患者103例、良性胸腔积液（BPE）患者92例（结核性胸腔积液59例、细菌性胸腔积液33例）。对所有纳入对象外周血样本中的LDH水平及胸腔积液样本中的ADA水平进行检测和比较，并计算血清LDH/胸腔积液ADA比值。通过ROC曲线评价血清LDH、胸腔积液ADA及其比值对MPE的诊断效能。结果 MPE组患者的血清LDH水平及血清LDH/胸腔积液ADA比值均高于BPE组［215.00（185.00，269.00）U/L vs 175.00（155.25，207.75）U/L，29.17（21.57，44.83）vs 6.96（5.05，11.48）；P均＜0.001］，而胸腔积液ADA水平低于BPE组［8.00（6.00，10.00）U/L vs 26.50（14.00，36.00）U/L，P＜0.001］。血清LDH、胸腔积液ADA和血清LDH/胸腔积液ADA比值联合检测具有较高的灵敏度和阳性预测值，其中以血清LDH联合血清LDH/胸腔积液ADA比值检测诊断MPE的灵敏度和阳性预测值最高，分别达到0.95和0.94。结论 血清LDH、胸腔积液ADA及血清LDH/胸腔积液ADA比值对MPE有较高的诊断效能，联合检测在保持较好的灵敏度的同时，也能提供较高的阳性预测值，以血清LDH联合血清LDH/胸腔积液ADA比值为最佳，可以更早地区分胸腔积液的良恶性，对临床决策具有一定的参考价值。 |
| 关键词: 恶性胸腔积液 血清乳酸脱氢酶 胸腔积液腺苷脱氨酶 血清乳酸脱氢酶/胸腔积液腺苷脱氨酶比值 |
| DOI：10.16781/j.CN31-2187/R.20220588 |
| 投稿时间：2022-07-14修订日期：2023-03-07 |
| 基金项目:安庆市自筹经费科技计划项目(2021Z2014). |
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| Roles of serum lactate dehydrogenase, pleural effusion adenosine deaminase and their ratio in diagnosing malignant pleural effusion |
| FENG Xiao-li1,2,ZHOU Ming2,CHEN Jin3,ZHANG Yong1* |
(1. Department of Geriatric Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui, China;
2. Department of Geratology, Anqing Municipal Hospital, Anqing 246000, Anhui, China;
3. Department of Endocrinology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the roles of serum lactate dehydrogenase (LDH), pleural effusion adenosine deaminase (ADA) and their ratio in diagnosing malignant pleural effusion (MPE). Methods A retrospective analysis of 195 hospitalized patients with exudative pleural effusion from Nov. 2019 to Aug. 2022 was conducted. The patients were divided into 2 groups: MPE group (n＝103) and benign pleural effusion (BPE) group (n＝92, including 59 cases with tuberculous pleural effusion and 33 cases with bacterial pleural effusion). LDH levels in the peripheral blood samples and ADA levels in the pleural effusion samples were measured and compared in all enrolled subjects, and serum LDH/pleural effusion ADA ratios were calculated. The diagnostic efficacy of serum LDH, pleural effusion ADA and their ratio for MPE was evaluated by receiver operating characteristic curves. Results Patients in the MPE group had higher serum LDH levels and serum LDH/pleural effusion ADA ratios than those in the BPE group (215.00 ［185.00, 269.00］ U/L vs 175.00 ［155.25, 207.75］ U/L, 29.17 ［21.57, 44.83］ vs 6.96［5.05, 11.48］; both P＜0.001). Pleural effusion ADA levels of patients in the MPE group were lower than those in the BPE group (8.00 ［6.00, 10.00］ U/L vs 26.50 ［14.00, 36.00］ U/L, P＜0.001). The combined test of serum LDH, pleural effusion ADA and their ratio had high sensitivity and positive predictive values, among which the sensitivity and positive predictive value of serum LDH combined with serum LDH/pleural effusion ADA ratio were the highest for the diagnosis of MPE, reaching 0.95 and 0.94, respectively. Conclusion Serum LDH, pleural effusion ADA and their ratio have high diagnostic efficacy for MPE. The combined test can maintain the sensitivity and increase the positive predictive value, and serum LDH combined with serum LDH/pleural effusion ADA ratio is the best, which can distinguish benign and malignant pleural effusion earlier and has reference value for clinical decision making. |
| Key words: malignant pleural effusion serum lactate dehydrogenase pleural effusion adenosine deaminase serum lactate dehydrogenase/pleural effusion adenosine deaminase ratio |
