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目的探讨胸腔积液腺苷脱氨酶(ADA)对不同年龄段的结核性胸膜炎的诊断价值。方法回顾性分析2010年5月至2016年4月经内科胸腔镜下活检明确诊断为结核性胸腔积液或恶性胸腔积液病例共592例,分为青年组、中年组和老年组,根据受试者工作曲线(ROC曲线)确定诊断结核性胸膜炎的ADA最佳临界值,并分析性别、年龄对ADA的影响。结果结核性胸腔积液的ADA水平在青年组、中年组和老年组均高于恶性胸腔积液,差异有统计学意义(P均<0.05)。胸腔积液ADA的水平与患者性别无关(P>0.05);不同年龄组的胸腔积液ADA不全相同(P<0.05),进一步两两比较,任两组间差异均有统计学意义;进一步相关分析,ADA与年龄的相关系数为-0.682,表明ADA与年龄呈负相关。作ROC曲线,ADA诊断结核性胸腔积液的曲线下面积(AUC)为0.984,最佳临界值为28.5 U/L,其灵敏度为94.06%,特异度为98.94%。分别作青年组、中年组和老年组的ROC曲线,AUC分别为0.984、0.975和0.969,ADA最佳临界值为37.5 U/L、26 U/L和26 U/L。结论胸腔积液ADA对结核性胸膜炎的诊断有帮助,随着年龄增大ADA水平下降,根据ROC曲线选择最佳ADA临界值较使用传统的ADA临界值,也许能提高结核性胸膜炎诊断的准确性。
Objective To investigate the diagnostic value of pleural effusion adenosine deaminase (ADA) in patients with tuberculous pleurisy of different ages. Methods A total of 592 cases of tuberculous pleural effusion or malignant pleural effusion diagnosed by medical thoracoscopic biopsy from May 2010 to April 2016 were retrospectively analyzed. They were divided into young group, middle-aged group and elderly group. The working curve (ROC curve) was used to determine the ADA threshold for the diagnosis of tuberculous pleurisy and to analyze the influence of gender and age on ADA. Results The levels of ADA in tuberculous pleural effusion were higher than those in malignant pleural effusion in young group, middle age group and elderly group (all P <0.05). Pleural effusion ADA levels have nothing to do with the gender of patients (P> 0.05); pleural effusion ADA different age groups were not the same (P <0.05), further any pairwise comparison, any difference between the two groups were statistically significant; further correlation Analysis, ADA and age correlation coefficient was -0.682, indicating that ADA was negatively correlated with age. For the ROC curve, the area under the curve (AUC) of ADA in the diagnosis of tuberculous pleural effusion was 0.984, the best cut-off value was 28.5 U / L, the sensitivity was 94.06% and the specificity was 98.94%. The ROC curves of young group, middle aged group and elderly group were 0.984, 0.975 and 0.969, respectively. The best critical values of ADA were 37.5 U / L, 26 U / L and 26 U / L. Conclusions Pleural effusion ADA is helpful in the diagnosis of tuberculous pleurisy. The ADA level declines with age. Choosing the best ADA cutoff value based on ROC curve compared with the traditional ADA cutoff value may improve the diagnostic accuracy of tuberculous pleurisy .