Application in the identification of a number of detection performance pleural effusion with the guiding principles of evidence-based laboratory medicine
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摘要:
目的 探讨循证检验医学原则指导下对多项检测在胸腔积液性能鉴别的临床应用价值。 方法 应用化学发光免疫分析法、光学比色法、固相酶免疫法、皮试法、血沉按国际标准法分别对已确诊的肺癌、肺结核、肺部感染胸腔积液100例患者的血清及胸腔积液同时进行癌胚抗原，糖类抗原199，鳞癌相关抗原、可溶性细胞角质蛋白片断19和神经原特异烯醇化酶、腺苷脱氨酶及乳酸脱氢酶、结核菌素试验、结核抗体免疫球蛋白G、红细胞沉降率等10项检测。 结果肿瘤标志物及LDH:肺癌组明显高于结核组和感染组，胸腔积液两者有显著差异(P＜0.05);ADA:结核组阳性率达92%，肺癌组及感染组则正常;PPD:结核组阳性率为62%，感染组为50%，肺癌组为19.2%;TBAb-IgG:结核组仅为4%，而肺癌组和感染组均为阴性;ESR增高率:结核组为94%，肺癌组为84.6%，感染组为83.3%。结论在循证检验医学原则指导下，用诊断性试验的特征值对癌性、结核性、炎症性胸腔积液性质鉴别作客观评价，为临床医生选择试验项目提供依据。实验证明胸腔积液检测肿瘤标志物水平和酶活性的灵敏度、特异性均明显高于血清，用于鉴别3种积液性质更有价值。 Abstract:Objective To investigate the clinical value of evidence-based examination of medical principles under the guidance of a number of detection performance in the identification of pleural effusion. Methods Serum and chemiluminescence immunoassay, optical assay, solid phase enzyme immunoassay, skin test method and blood sedimentation method was used to international standards that were diagnosed with lung cancer, tuberculosis, pleural effusion, pulmonary infection in 100 patients pleural effusion simultaneous CEA, CA199, CF211, NSE, SCCAg, LDH, ADA, PPD, TBAb-IgG, ESR and other 10 test. Results The tumor markers and LDH: lung cancer group were significantly higher than tuberculosis and infection, pleural effusion there are significant differences (P＜0.05); ADA: The positive rate of 92% of tuberculosis, lung cancer and infection group were normal; PPD: TB -positive group was 62% , the infected group was 50%, lung cancer group was 19.2%; TBAb-IgG: TB group was 4%, while the lung cancer group and infection group were negative; ESR increased rate: tuberculosis group 94% of lung cancer group was 84.6, the infected group was 83.3% . Conclusion Under the guidance of the principles of evidence-based laboratory medicine, diagnostic tests with the eigenvalues of cancer, tuberculosi, inflammation of the pleural effusions make an objective evaluation and provide the basis for the clinician to select pilot projects. Pleural effusion detection of tumor marker levels and activity of the sensitivity, specificity is significantly higher than the serum used to identify three kinds of fluid nature of the more valuable. -
Key words:
- evidence-based laboratory medicine /
- pleural effusion /
- tumor markers /
- lung /
- tuberculosis /
- infection
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表 1 3组胸腔积液患者10项检测结果
检测项目 标本 肺癌组 结核组 SEN(%) SPE(%) ACC(%) SEN(%) SGE(%) ACC(%) CEA S 57.7 95.9 86 0 66 33 PE 80.8 96.4 91 0 50 25 CA199 S 38.5 93.2 79 0 0 50 PE 61.5 94.6 86 0 0 50 CF211 S 76.9 0 94 0 56 28 PE 80.8 83.8 83 0 82 41 NSE S 61.5 77 73 0 78 35 PE 61.5 71.6 69 0 38 19 SCCAg S 0 93.2 69 0 94 47 PE 3.8 87.8 66 0 90 45 LDH S 57.7 78.4 73 20 60 40 PE 88.5 9.4 30 98 18 58 ADA PE 7.7 54.1 42 92 96 94 
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表 2 诊断性试验对2组胸腔积液患者性能鉴定评价结果
检测项目 标本 肺癌组 结核组 感染组 阳性率（%） X S P 阳性率（%） X S P 阳性率（%） X S P CEA S 57.7 666.9 2539.7 ＜0.05 0 1.3 0.9 ＜0.05 0 4.5 10.9 ＜0.05 PE 80.8 1864.6 3568.7 0 1.5 1.5 0 11.9 31.1 CA199 S 38.5 1126.4 2631.7 ＜0.05 0 11.1 8 ＞0.05 0 17.2 18.6 ＞0.05 PE 61.5 2734.8 4591.6 0 10.4 8.8 0 20.8 21.9 CF211 S 76.9 12.6 16.1 ＜0.05 0 1.5 0.6 ＜0.05 0 1.7 0.8 ＞0.05 PE 80.8 33.5 36.7 0 4.1 5.2 0 3.3 1.7 NSE S 61.5 19.3 15.8 ＞0.05 0 15.1 1.8 ＞0.05 0 10.5 4.8 ＞0.05 PE 61.5 21.4 13.1 0 13.9 1.2 0 12.3 5.1 SCCAg S 0 1.8 0.4 ＜0.05 0 0.6 0.1 ＜0.05 12.5 1.1 1.1 ＞0.05 PE 3.8 4.4 9.5 0 1.2 0.2 12.5 1.5 1.3 LDH S 57.7 408 587.1 ＜0.05 20 184 50.4 ＜0.05 20.8 181.7 60.1 ＜0.05 PE 88.5 1095 1049.7 98 535 271.8 70.8 612.8 455.6 ADA S 7.7 11.8 10.7 － 92 45.7 11.4 － 0 13.1 6 － PPD AST 19.2 － － － 62 － － － 50 － － － TBAb-IgG S 0 － － － 4 － － － 0 － － － ESR B 84.6 51.3 38.7 － 94 60.1 25.9 － 83.3 72.6 41.5 －
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