胸水中D-dimer浓度与胸膜组织病理学检查对结核性胸膜炎的诊断价值

摘要

目的:探讨胸水中D-dimer水平检测与胸膜组织病理学检查(CNPB)两种方法对结核性胸膜炎的诊断价值.方法:收集110例结核性胸膜炎及121例非结核性胸膜炎患者的胸水,采用Beckman高效液相色谱仪、干式免疫散射色谱法检测胸水中D-dimer浓度;同时用Cope针采集胸膜标本常规苏木素-伊红染色,以检出肉芽肿性病变确诊结核性胸膜炎;以D-dimer浓度阈值制作受试者操作曲线(ROC),比较两种检查方法对结核性胸膜炎诊断的灵敏度、特异度、预测值和准确度,以ROC曲线下面积(AUC) ＞0.5认为具有诊断价值.结果:结核性胸水中D-dimer浓度高于非结核性胸腔积液,差异具有统计学意义(P＜0.05);对于结核性胸膜炎的诊断,D-dimer敏感性明显高于CNPB(P ＜0.05),D-dimer的特异性、阳性预测值明显低于CNPB(P＜0.05);D-dimer的ROC曲线中AUC值虽然高于CNPB的AUC值,但是不具有统计学意义(P＞0.05);D-dimer对结核性胸膜炎诊断的最佳截断值为≥283.21 mg,/L.结论:D-dimer检测是一种准确率较高的结核性胸膜炎的诊断方法,可以辅助结核性胸膜炎的诊断.%Objective:To compare the diagnostic value of hydrothorax D-dimer concentration test and pleura histopathology on diagnosing tuberculous pleurisy.Methods:Collecting hydrothorax of 110 tuberculous pleurisy cases and 121 non-tuberculous pleurisy,adopting Beckman HPLC,Dry Immune Scattered Chromatography to detect concentration level of D-dimer in hydrothorax;meanwhile,adopting Cope needle to collect regular hematoxylin and eosin stain in pleural specimens in order to detect the granulomatous lesion to diagnose tuberculous pleurisy.Creating ROC on D-dimer concentration threshold value,comparing sensitivity,specificity,predictive value and accuracy of diagnosing tuberculous pleurisy from both assays;ROC AUC ＞ 0.5 is considered with diagnostic value.Results:Tuberculous pleurisy hydrothorax D-dimer concentration is higher than non-tuberculous pleurisy hydrothorax,difference was statistically significant (P ＜ 0.05).Concerning diagnosing tuberculous pleurisy,D-dimer sensitivity was obviously higher than CNPB (P ＜ 0.05);while specificity,positive predictive value was obviously lower than CNPB (P ＜ 0.05);AUC value of ROC curve of D-dimer was higher than that of CNPB,but it showed no statistical significance(P ＜0.05);the best cutoff value of D-dimer on diagnosing tuberculous pleurisy was ≥ 283.21 mg/L.Conclusion:D-dimer assay could serve as a better way of diagnosing tuberculous pleurisy.