IL-10和IL-12检测在结核性和恶性胸腔积液鉴别诊断中的应用

摘要

目的:通过检测结核性和恶性胸腔积液患者血清和胸腔积液中白细胞介素10(IL-10)和白细胞介素12(IL-12)的水平,探讨二者对于鉴别结核性和恶性胸腔积液的价值.方法:选取住院未经治疗的渗出性胸腔积液患者48例,根据病因分为结核性胸腔积液组25例和恶性胸腔积液组23例.采用流式微球阵列法(CBA)检测2组患者血清和胸腔积液中IL-10和IL-12的水平,比较2组患者IL-10、IL-12水平和IL-12/IL-10比值的差异;通过受试者工作特征(ROC)曲线分析上述指标与胸水脱落细胞和腺苷脱氢酶(ADA)在鉴别结核性和恶性胸腔积液中的作用.结果:结核性胸腔积液组和恶性胸腔积液组患者血清中IL-10、IL-12水平和IL-12/IL-10比值比较差异无统计学意义(P> 0.05),恶性胸腔积液组患者胸腔积液中IL-12水平和IL-12/IL-10比值明显低于结核性胸腔积液组(P< 0.01).利用胸腔积液IL-12水平鉴别结核性和恶性胸腔积液的ROC曲线下面积为0.984,明显高于IL-12/IL-10比值(0.744)、脱落细胞(0.804)和ADA(0.911).结论:胸腔积液中IL-12水平检测有助于结核性和恶性胸腔积液的鉴别诊断,且标本容易获取,值得临床上推广应用.%Objective:To investigate the role of interleukin-10 (IL-10) and IL-12 in the differential diagnosis of tuberculous and malignant pleural effusion through measuring the serum and pleural effusion IL-10 and IL-12 levels of tuberculous and malignant pleural effusion patients.Methods: Forty-eight inpatients with exudative pleural effusion who didn''t receive any treatment before were selected.According to the pathogeny, the patients were divided into tuberculous pleural effusion group (n=25) and malignant pleural effusion group (n=23).The levels of IL-10 and IL-12 in peripheral blood and pleural effusion of the patients in two groups were detected by Cytometric Bead Array (CBA).The differences in IL-10, IL-12 levels and IL-12/IL-10 ratio were compared between two groups.The ROC curves of the above indexes, cast-off and adenosine deaminase (ADA) were used to compare the effects in differential diagnosis of tuberculous and malignant pleural effusion.Results: There were no statistical differences in the levels of serum IL-10, IL-12 and IL-12/IL-10 ratios of the patients between tuberculous and malignant pleural effusion groups (P>0.05),and the IL-12 level in pleural effusion and the IL-12/IL-10 ratio of the patients in malignant pleural effusion group were lower than those in tuberculous pleural effusion group (P<0.005).The area under the ROC curve for the levels of IL-12 in pleural effusion (0.984) was higher than those for the ratio of IL-12/IL-10, cast-off and ADA (0.744, 0.804 and 0.911, respectively) in the differential diagnosis of tuberculous and malignant pleural effusion.Conclusion: The detection of IL-12 levels in pleural effusion is helpful for the differential diagnosis of tuberculous and malignant pleural effusion, and the pleural effusion is easy to obtain, therefore the detection of IL-12 in pleural effusion is worth to be widely applied in clinic.