胸腔积液腺苷脱氨酶、全血γ-干扰素和白细胞介素2检测对结核性胸膜炎的诊断价值

doi:10.19983/j.issn.2096-8493.20250068

摘要/Abstract

摘要：

目的: 探讨胸腔积液腺苷脱氨酶(ADA)、全血γ-干扰素(IFN-γ)和白细胞介素2(IL-2)对结核性胸膜炎(TBP)的诊断效能。方法: 采用回顾性研究方法,参照入组标准收集2023—2024年就诊于兰州市肺科医院的353例胸腔积液患者的相关临床信息,包括患者性别、年龄、胸腔积液ADA、胸腔积液和血清总蛋白(TP)和乳酸脱氢酶(LDH)水平、全血IFN-γ和IL-2水平。以临床最终诊断为参照标准,将患者分为TBP组(193例)和非TBP组(160例)。分析两组患者的ADA、IFN-γ和IL-2水平,并以受试者工作特征曲线下面积(AUC)、敏感度、特异度、Kappa值评估各指标单独和联合检测对TBP的诊断效能。结果: TBP组ADA、IFN-γ、IL-2水平[分别为35.00(19.00,46.90)U/L、13.50(1.42,65.26)pg/ml、6.32(0.67,43.36)pg/ml]均明显高于非TBP组[分别为9.00(5.00,20.00)U/L、2.95(0.00,15.06)pg/ml、2.38(0.00,13.52)pg/ml],差异均有统计学意义(Z=17.603,P<0.001;Z=14.816,P<0.001;Z=65.693,P<0.001)。单一指标检测中,ADA、IFN-γ、IL-2的检测敏感度分别为82.38%(159/193)、55.96%(108/193)、59.07%(114/193),特异度分别为67.50%(108/160)、71.88%(115/160)、62.50%(100/160),阳性预测值分别为75.36%(159/211)、70.59%(108/153)、65.52%(114/174),AUC值分别为0.800、0.649、0.605,Kappa值分别为0.459、0.257、0.177。联合检测中,ADA+IFN-γ、ADA+IL-2、IFN-γ+IL-2、ADA+IFN-γ+IL-2的检测敏感度分别为69.43%(134/193)、75.13%(145/193)、44.04%(85/193)、68.91%(133/193),特异度分别为80.00%(128/160)、75.00%(120/160)、81.25%(130/160)、82.50%(132/160),阳性预测值分别为80.72%(134/166)、78.38%(145/185)、73.91%(85/115)、82.61%(133/161),AUC值分别为0.807、0.800、0.644、0.808,Kappa值分别为0.387、0.452、0.249、0.410。结论: 胸腔积液ADA单一检测对诊断TBP具有较高的诊断效能,并在保证诊断效能的前提下与全血IFN-γ和IL-2联合检测时可提高诊断TBP的特异度和阳性预测值,从而提高检出率、降低漏诊率,可将联合检测策略应用于TBP的临床诊断,发挥其最大的诊断优势。

关键词: 结核,胸膜, 腺苷脱氨酶, 干扰素类, 白细胞介素2, 诊断

Abstract:

Objective: To evaluate the diagnostic performance of pleural fluid adenosine deaminase (ADA), whole blood γ-interferon (IFN-γ), and interleukin-2 (IL-2) in tuberculous pleurisy (TBP). Methods: A retrospective study was conducted, clinical data from 353 patients with pleural effusion admitted to Lanzhou Chest Hospital between 2023 and 2024 were collected. The data included gender, age, ADA levels, serum total protein (TP) and lactate dehydrogenase (LDH) levels, as well as whole blood IFN-γ and IL-2 levels. Based on the final clinical diagnosis, patients were divided into a TBP group (n=193) and a non-TBP group (n=160). The levels of ADA, IFN-γ, and IL-2 levels were compared. The diagnostic efficacy of each indicator individually and in combination were evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Kappa values. Results: The levels of ADA, IFN-γ, and IL-2 (35.00 (19.00, 46.90) U/L, 13.50 (1.42, 65.26) pg/ml, and 6.32 (0.67, 43.36) pg/ml, respectively) in the TBP group were significantly higher than those in the control group (9.00 (5.00, 20.00) U/L, 2.95 (0.00, 15.06) pg/ml, and 2.38 (0.00, 13.52) pg/ml, respectively)(Z=17.603, P<0.001; Z=14.816, P<0.001; Z=65.693, P<0.001). For individual indicators, the sensitivities of ADA, IFN-γ, and IL-2 were 82.38% (159/193), 55.96% (108/193), and 59.07% (114/193); the specificities were 67.50% (108/160), 71.88% (115/160), and 62.50% (100/160), respectively; the positive predictive values were 75.36% (159/211), 70.59% (108/153), and 65.52% (114/174), the AUC values were 0.800, 0.649, and 0.605, and Kappa values were 0.459, 0.257, and 0.177, respectively. For combined detection, the sensitivities of ADA+IFN-γ, ADA+IL-2, IFN-γ+IL-2, and ADA+IFN-γ+IL-2 were 69.43% (134/193), 75.13% (145/193), 44.04% (85/193), and 68.91% (133/193), respectively, while the specificities were 80.00% (128/160), 75.00% (120/160), 81.25% (130/160), and 82.50% (132/160), respectively. The positive predictive values were 80.72% (134/166), 78.38% (145/185), 73.91% (85/115), and 82.61% (133/161). The corresponding AUC values were 0.807, 0.800, 0.644, and 0.808, and Kappa values were 0.387, 0.452, 0.249, and 0.410, respectively. Conclusion: Pleural fluid ADA alone demonstrates high diagnostic efficiency for TBP. When combined with whole blood IFN-γ and IL-2, it further improves the specificity and positive predictive value without compromising diagnostic performance, thereby increasing detection rates and reducing missed diagnoses. The combined detection strategy can be applied in the clinical diagnosis of TBP to maximize its diagnostic advantages.

Key words: Tuberculosis, pleural, Adenosine deaminase, Interferons, Interleukin-2, Diagnosis

中图分类号:

R52
R561

魏黛珏, 同重湘. 胸腔积液腺苷脱氨酶、全血γ-干扰素和白细胞介素2检测对结核性胸膜炎的诊断价值[J]. 结核与肺部疾病杂志, 2025, 6(5): 525-531. doi: 10.19983/j.issn.2096-8493.20250068

Wei Daijue, Tong Chongxiang. The diagnostic value of adenosine deaminase in pleural fluid, whole blood γ-interferon, and interleukin-2 for tuberculous pleurisy[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(5): 525-531. doi: 10.19983/j.issn.2096-8493.20250068

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指标	TBP组(193例)	非TBP组(160例)	Z值	P值
胸腔积液TP[g/L, M(Q₁,Q₃)]	45.70(39.75,50.50)	36.90(27.23,43.65)	7.593	<0.001
胸腔积液LDH[U/L, M(Q₁,Q₃)]	47.70(39.75,50.50)	213.50(120.00,499.00)	0.197	0.844
血清TP[g/L, M(Q₁,Q₃)]	64.00(58.65,69.80)	61.85(56.00,67.85)	2.643	0.009
血清LDH[U/L, M(Q₁,Q₃)]	184.00(150.50,218.50)	178.50(151.25,229.25)	-0.428	0.669
胸腔积液TP/血清TP	0.70(0.63,0.77)	0.60(0.45,0.68)	6.945	<0.001
胸腔积液LDH/血清LDH	1.89(1.18,3.20)	1.19(0.67,2.31)	-0.061	0.952