降钙素原和端粒酶在胸腔积液鉴别诊断中的作用研究
【摘要】 目的：探讨降钙素原及端粒酶活性检测在胸腔积液鉴别诊断中的敏感度及特异度，以及两者联合是否可提高胸腔积液鉴别诊断的敏感度及特异度。方法：回顾性分析诊断明确的类肺炎性胸腔积液（炎症组）、结核性胸腔积液（结核组）、癌性胸腔积液患者（癌性组）的临床資料，收集、检测三组患者胸腔积液标本中降钙素原和端粒酶活性并进行比较。结果：炎症组降钙素原最高为（0.990±0.200）ng/mL、结核组为（0.560±0.057）ng/mL、癌性组最低为（0.380±0.067）ng/mL，三组间两两比较差异均有统计学意义（P<0.05）。癌性组端粒酶活性为（206.39±8.46），与炎症组的（182.63±27.46）和结核组的（192.17±13.74）比较，差异均有统计学意义（P<0.05）；炎症组与结核组比较，差异无统计学意义（P>0.05）。在诊断价值分析方面，当降钙素原>0.75 ng/mL时，支持类肺炎性胸腔积液诊断；当降钙素原>0.485 ng/mL且≤0.75 ng/mL时，支持结核性胸腔积液诊断；当降钙素原≤0.485 ng/mL时，支持癌性胸腔积液诊断。当端粒酶活性≥205时强烈支持癌性胸腔积液诊断，但是当端粒酶<205时，无法鉴别类肺炎性还是结核性胸腔积液。进一步通过等级logistic回归分析发现，降钙素原与端粒酶联合检测对于胸腔积液的诊断界值很好。结论：联合检测PCT、端粒酶活性在类炎性胸腔积液、结核性胸腔积液及癌性胸腔积液的鉴别诊断中有较好的作用。
【关键词】 胸腔积液； 降钙素原； 端粒酶； 类肺炎性胸腔积液； 结核性胸腔积液； 癌症性胸腔积液
【Abstract】 Objective：To investigate the of procalcitonin and telomerase in differential diagnosis of pleural effusion，and whether the combination of them can improve the sensitivity and specificity of differential diagnosis of pleural effusion.Method：The clinical data of patients with pleural effusion（inflammatory group），tuberculous pleural effusion（tuberculous group） and malignant pleural effusion（cancer group） were retrospectively analyzed，the procalcitonin and telomerase activity in three groups of patients with pleural effusion were collected and compared.Result：The highest level of procalcitonin in the inflammatory group was （0.990±0.200）ng/mL，and the tuberculosis group was （0.560±0.057）ng/mL，the lowest in the cancer group was （0.380±0.067）ng/mL，the difference between two groups were statistically significant（P<0.05）.The telomerase activity in the cancerous group was （206.39±8.46），compared with the inflammatory group （182.63±27.46） and the tuberculosis group （192.17±13.74），the differences were statistically significant（P<0.05）.There was no significant difference between the inflammatory group and the tuberculosis group（P>0.05）.The diagnostic value of procalcitonin，when >0.75 ng/mL，supported the type of pleural effusion when the diagnosis of pneumonia；when the procalcitonin was less than or equal to 0.75 ng/mL，and higher than 0.485 ng/mL，supported the diagnosis of tuberculous pleural effusion；when the procalcitonin was less than or equal to 0.485 ng/mL，supported the diagnosis of malignant pleural effusion.When the telomerase activity was 205 or more strongly supports the diagnosis of malignant pleural effusion，but when telomerase was less than 205，unable to distinguish the kinds of pneumonia or tuberculous pleural effusion.Further through the hierarchical logistic regression analysis，it was found that the combined detection of calcitonin and telomerase was good for the diagnosis of pleural effusion.Conclusion：The combined detection of procalcitonin and telomerase may play an important role in the differential diagnosis of parapneumonic pleural effusion，tuberculous pleural effusion and malignant pleural effusion.