胸腔积液中B7-H4蛋白联合ADA和CEA水平检测在胸腔积液鉴别诊断中的应用价值

doi:10.13481/j.1671-587x.20200329

摘要/Abstract

摘要： 目的：检测肺癌性胸腔积液（LC-MPE）和结核性胸腔积液（TPE）中B7-H4蛋白、腺苷脱氨酶（ADA）和癌胚抗原（CEA）水平，评价其单独或联合检测对LC-MPE与TPE的鉴别诊断价值。方法：收集120例肺癌患者（LC-MPE组）和82例结核性胸膜炎患者（TPE组）共202例胸腔积液（PE）样本。采用酶速率法、电化学发光法和ELISA法检测2组患者PE中ADA、CEA和B7-H4蛋白水平，采用受试者工作特征曲线（ROC曲线）分析以确定单项指标以及联合模式的诊断效能指标[灵敏度、特异度、约登指数（YI）和ROC曲线下面积（AUC）]。结果：TPE组患者PE中ADA水平高于LC-MPE组（P<0.05）；LC-MPE组患者PE中B7-H4蛋白和CEA水平高于TPE组（P<0.05）；ROC曲线分析，ADA、CEA和B7-H4蛋白单项检测的灵敏度分别为93.30%、83.33%和79.90%，特异度分别为86.59%、96.34%和72.50%，AUC分别为0.927、0.925和0.836；平行试验检测，3项指标联合模式有最高的诊断价值，灵敏度为93.90%，特异度为97.50%，YI为0.914，AUC为0.989。结论：联合检测PE中ADA、CEA和B7-H4蛋白水平的诊断效能优于各指标单项评估，联合检测可提高LC-MPE和TPE的鉴别诊断效能。

关键词: 胸腔积液, 腺苷脱氨酶, 癌胚抗原, B7-H4蛋白, 结核性胸膜炎

Abstract: Objective: To detect the levels of B7-H4 protein, adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in the malignant pleural effusion associated with lung cancer (LC-MPE) and tuberculous pleural effusion (TPE), and to evaluate the values of single and combined detection of B7-H4 protein,ADA and CEA in differential diagnosis of LC-MPE and TPE. Methods: A total of 202 samples of pleural effusion(PE) from 120 LC-MPE patients(LC-MPE group) and 82 TPE patients(TPE group) were collected. The levels of ADA and CEA and B7-H4 protein in PE were detected by the enzymatic, electrochemiluminescence and ELISA methods, respectively; and the receiver operating characteristic curve(ROC curve) was used to determine the diagnostic efficiencies of the above indexes alone or in combination,such as the sensitivity,the specificity, the Yoden index(YI),and the area under ROC curve(AUC). Results: The level of ADA in PE of the patients in TPE group was higher than that in LC-MPE group (P<0.05); the levels of CEA and B7-H4 protein in PE of the patients in LC-MPE group were higher than those in TPE group (P<0.05).The ROC curve analysis results showed that the sensitivities of single detection of ADA, CEA and B7-H4 protein were 93.30%, 83.33% and 79.90%, respectively; the specificities were 86.59%, 96.34% and 72.50%, respectively; the AUC were 0.927, 0.925 and 0.836, respectively. The combined detection of the three indexes had the highest diagnostic value; the sensitivity was 93.90%, the specificity was 97.50%, the YI was 0.971, and the AUC was 0.998. Conclusion: The combined detection of levels of ADA, CEA and B7-H4 protein in PE is superior to the single evaluation of each index, which can greatly improve the differential diagnosis efficiencies of LC-MPE and TPE.

Key words: pleural effusion, adenosine deaminase, carcinoembryonic antigen, B7-H4 protein, tuberculous pleurisy

中图分类号:

R446.61

李锐成, 郜赵伟, 张惠中, 林芳, 刘冲, 董轲. 胸腔积液中B7-H4蛋白联合ADA和CEA水平检测在胸腔积液鉴别诊断中的应用价值[J]. 吉林大学学报(医学版), 2020, 46(03): 614-619.

LI Ruicheng, GAO Zhaowei, ZHANG Huizhong, LIN Fang, LIU Chong, DONG Ke. Application value of detection of B7-H4 protein level combined with ADA and CEA levels in pleural effusion in differential diagnosis of pleural effusion[J]. Journal of Jilin University(Medicine Edition), 2020, 46(03): 614-619.

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