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目的探讨血清乳酸脱氢酶(sLDH)/胸水腺苷脱氨酶(pADA)比值在鉴别恶性胸水中的应用价值。方法收集2012年7月-2016年3月温州医科大学附属第一医院住院患者各种胸水标本1 051例(包括恶性胸水标本344例,结核性胸水标本432例,炎性胸水标本275例)。采用速率法对pADA、sLDH、胸水乳酸脱氢酶(pLDH)进行检测,速率散射免疫比浊法来检测血清C-反应蛋白(sCRP),并结合临床资料对各组进行统计学分析。结果恶性胸水组sLDH/pADA高于结核性胸水组和炎性胸水组,差异均有统计学意义(P<0.05)。ROC曲线显示,sLDH/pADA临界值为10.623时的AUC最高(0.855),明显高于pADA(0.132)、sLDH(0.554)、sCRP(0.238)、pLDH(0.454)、pLDH/sLDH(0.426),此时sLDH/pADA诊断恶性胸水的灵敏度和特异度分别为92.8%和75.7%。结论 sLDH/pADA可作为鉴别诊断良恶性胸水的一种较好指标。
Objective To investigate the value of serum lactate dehydrogenase (sLDH) / pleural effusion adenosine deaminase (pADA) ratio in the differential diagnosis of malignant pleural effusion. Methods A total of 1,051 cases of pleural effusion (including 344 cases of malignant pleural effusion, 432 cases of tuberculous pleural effusion and 275 cases of inflammatory pleural effusion) were collected from July 2012 to March 2016 in the First Affiliated Hospital of Wenzhou Medical University. The velocity of pADA, sLDH and pleural fluid lactate dehydrogenase (pLDH) were detected by rate method, and the level of serum s-reactive protein (sCRP) was detected by rate-scattering immunoturbidimetry. Statistical analysis was performed on each group according to the clinical data. Results The sLDH / pADA in malignant pleural effusion group was higher than that in tuberculous pleural effusion group and inflammatory pleural effusion group (P <0.05). The ROC curve showed that the highest AUC (0.855) at sLDH / pADA cutoff of 10.623 was significantly higher than pADA (0.132), sLDH (0.554), sCRP (0.238), pLDH (0.454), pLDH / sLDH Sensitivity and specificity of sLDH / pADA in the diagnosis of malignant pleural effusion were 92.8% and 75.7%, respectively. Conclusion sLDH / pADA can be used as a good indicator in differential diagnosis of benign and malignant pleural effusion.