血浆LDH与胸腔积液ADA的比值在恶性胸腔积液中的诊断价值

摘要

Objective To study the diagnostic value of plasma LDH:pleural effusion ADA ratio in malignant pleural effusion.Methods The levels of LDH in plasma and pleural effusion,plasma LDH:ADA of pleural effusion ratio were analyzed retrospectively in 357 cases of exudative pleural effusion from October 2011 to May 2017.Results The levels of plasma LDH and plasma LDH:pleural effusion ADA were significantly higher in patients with malignant pleural effusion than those with tuberculous pleural effusion and pulmonary inflammatory effusion.The critical value of Plasma LDH:ADA of pleural effusion ratio was greater than 15,the sensitivity of diagnosis of malignant pleural effusion was 0.95 (95 ％ CI 0.91-0.99) and the specificity was 0.94 (95％ CI 0.85-0.98).The positive likelihood ratio was 36.1 (95％ CI 10.3-89.7) and the negative likelihood ratio was 0.03 (95％ CI 0.01-0.17).Conclusion Higher plasma LDH and plasma LDH:pleural fluid ADA ratio in patients presenting with exudative pleural effusion can distinguish between malignant and non-malignant effusion on the first day of hospitalization.The cut-off level for plasma LDH:pleural fluid ADA ratio of＞20 is highly predictive of malignancy in patients with exudative pleural effusion with high sensitivity and specificity.%目的 研究血浆乳酸脱氢酶(LDH)与胸腔积液腺苷脱氨酶(ADA)比值在恶性胸腔积液中的诊断价值.方法 回顾性分析2011年10月～2017年5月就诊的357例渗出性胸腔积液患者血液、胸腔积液的LDH水平,血浆LDH与胸腔积液ADA比值.结果 恶性胸腔积液患者血浆LDH和血浆LDH与胸腔积液ADA比值明显高于结核性胸腔积液和类肺炎性积液患者.血浆LDH与胸腔积液ADA比值的临界值＞15时,诊断恶性胸腔积液的灵敏度为0.95 (95％CI0.91-0.99),特异度为0.94(95％CI 0.85-0.98).阳性似然比为36.1(95％CI 10.3-89.7),而阴性似然比为0.03(95％CI0.01-0.17).结论 渗出性胸腔积液患者的血浆LDH和血浆LDH胸腔积液ADA比值可以更平地区分胸腔积液的良恶性.血浆LDH与胸腔积液ADA比例的临界值＞15时,预测恶性渗出性胸腔积液具有高灵敏度和特异性.