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目的研究胸腔积液中白细胞介素18(IL-18)检测在结核性胸腔积液和恶性胸腔积液的鉴别诊断中的临床价值。方法以2008年10月至2009年2月在黑龙江省传染病院未经治疗的结核性胸腔积液患者30例、恶性胸腔积液患者30例及同期体检合格的健康者30例为研究对象。采用夹心酶联免疫吸附测定法(ELISA)检测胸腔积液患者胸水和血清中IL-18浓度及健康者的血清中IL-18浓度。本研究旨在探讨测定胸腔积液中IL-18浓度对于诊断结核性胸腔积液的临床意义。结果①结核性胸腔积液组与恶性胸腔积液组患者血清IL-18浓度差别无统计学意义(P>0.05)。结核性胸腔积液组患者胸水中IL-18的浓度显著高于恶性胸腔积液组。②ROC曲线分析结果显示,胸水中IL-18的诊断临界值为503.88pg/ml,诊断敏感度为86.67%、特异度为93.33%、准确度为90%。结论血清IL-18对结核性胸腔积液和恶性胸腔积液之间的鉴别无诊断价值,胸腔积液中IL-18可作为临床鉴别结核性和恶性胸腔积液的有效指标,具有一定的临床价值。
Objective To study the clinical value of detecting interleukin 18 (IL-18) in pleural effusion in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion. Methods Thirty patients with tuberculous pleural effusion, 30 patients with malignant pleural effusion and 30 healthy persons who passed physical examinations during the same period were enrolled in this study from October 2008 to February 2009 in Heilongjiang Provincial Infectious Diseases Hospital. The concentrations of IL-18 in pleural effusion and serum and IL-18 in serum of healthy persons were measured by sandwich enzyme-linked immunosorbent assay (ELISA). This study aimed to investigate the clinical significance of determining IL-18 concentration in pleural effusion for the diagnosis of tuberculous pleural effusion. Results ① There was no significant difference in serum IL-18 levels between tuberculous pleural effusion group and malignant pleural effusion group (P> 0.05). The concentration of IL-18 in pleural effusion was significantly higher in patients with tuberculous pleural effusion than in malignant pleural effusion. The results of ROC curve analysis showed that the diagnostic threshold of IL-18 in pleural effusion was 503.88pg / ml, the diagnostic sensitivity was 86.67%, the specificity was 93.33% and the accuracy was 90%. Conclusion Serum IL-18 has no diagnostic value in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion. IL-18 in pleural effusion can be used as an effective index to differentiate tuberculous and malignant pleural effusion. It has some clinical significance value.