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目的探讨胸腔镜与蛋白指纹图谱检测技术(PFT),在恶性和结核性胸腔积液早期诊断中的作用。方法2009年1月至2010年12月福建省福州肺科医院住院经影像学检查发现有胸腔积液,经内科胸腔镜检查、病理学(或细菌学)、胸腔积液蛋白指纹图谱检测临床确诊的121例住院患者,选择无其他并存病,经胸腔镜检测病理确诊的恶性胸腔积液患者30例(Ⅰ组)和结核性胸腔积液患者50例(Ⅱ组),同时进行胸腔积液蛋白指纹图谱检测,分析其相关蛋白峰值并进行统计学处理。结果Ⅰ组和Ⅱ组行蛋白指纹图谱检测,两组间有7个差异蛋白峰(分别为5335、8048、11 700、11 670、15 982、11 683、7700m/z),依据蛋白峰值表达情况,以11 670、11 700m/z的蛋白峰用于建立恶性胸腔积液诊断模型,诊断Ⅰ组阳性率达83.3%(25/30),Ⅱ组为24.0%(12/50),两组差异有显著统计学意义(χ2=26.55,P<0.01),倾向于判定恶性胸腔积液;其敏感度为83.3%(25/30),特异度为76.0%(38/50);以5335、8048m/z用于建立结核性胸腔积液诊断模型,2种蛋白峰建立Ⅰ组与Ⅱ组的鉴别诊断模型结果,诊断Ⅰ组阳性率达16.7%(5/30),Ⅱ组为52.0%(26/50),两组差异有显著统计学意义(χ2=9.86,P<0.01),倾向于判定结核性胸深积液;其敏感度为52.0%(26/50),特异度为83.3%(25/30)。结论胸液蛋白指纹图谱检测技术简便、快速,是鉴别结核性与恶性胸腔积液特异性标志物的有效手段,但尚需在判读方法上做进一步深入研究。
Objective To investigate the diagnostic value of thoracoscope and protein fingerprinting (PFT) in the early diagnosis of malignant and tuberculous pleural effusion. Methods From January 2009 to December 2010, the hospital of Fuzhou Pulmonary Hospital of Fujian Province was diagnosed as having pleural effusion by medical imaging examination, pathological (or bacteriological), pleural effusion protein fingerprinting Of 121 inpatients, 30 patients with malignant pleural effusion diagnosed by thoracoscopy (group Ⅰ) and 50 patients with tuberculous pleural effusion (group Ⅱ) were selected as the inpatients with no other comorbid conditions. At the same time, pleural effusion protein Fingerprint detection, analysis of the peak of related proteins and statistical analysis. Results The protein fingerprints of group Ⅰ and group Ⅱ were detected. There were 7 differential protein peaks between the two groups (5335, 8048, 11 700, 11 670, 15 982, 11 683 and 7700 m / z, respectively) . The protein peak of 11 670 and 11 700 m / z was used to establish the diagnostic model of malignant pleural effusion. The positive rate of diagnosis in group Ⅰ was 83.3% (25/30) and that in group Ⅱ was 24.0% (12/50) (Χ2 = 26.55, P <0.01). The sensitivity was 83.3% (25/30) and the specificity was 76.0% (38/50). The sensitivity and specificity were 5335 and 8048 m / z was used to establish a diagnostic model of tuberculous pleural effusion. Two kinds of protein peaks were used to establish the differential diagnosis model of group Ⅰ and group Ⅱ. The positive rate of diagnosis in group Ⅰ was 16.7% (5/30), in group Ⅱ 52.0% (26 / 50). The difference between the two groups was statistically significant (χ2 = 9.86, P <0.01), and the sensitivity was 52.0% (26/50) and the specificity was 83.3% 25/30). Conclusion Pleural fluid protein fingerprinting is a simple and rapid method for identifying tuberculous and malignant pleural effusion. However, further study on interpretation is still needed.