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目的探讨胸水与血清中的半胱氨酸蛋白酶抑制剂C(Cys C)在结核性胸膜炎诊断中的临床价值。方法随机抽取2014年邯郸市传染病医院收治的结核性胸膜炎患者116例(结核组),肝性胸水50例(对照组),对胸水和血清中的Cys C、腺苷脱氨酶(ADA)进行测量,分别计算胸水与血清中含量的比值。结果 1两组中胸水腺苷脱氨酶(PADA)、血清腺苷脱氨酶(SADA)、血清半胱氨酸蛋白酶抑制剂C(SCys C)、胸水与血清中的Cys C比值(PCys C/SCys C)和胸水与血清中的ADA比值(PADA/SADA)相比,差异具有统计学意义(P<0.01)。2在结核组中,以PADA/SADA>2为诊断依据,作出ROC曲线。根据ROC曲线“敏感度+特异度”取最大值原则,确立PCys C/SCys C和PCys C的临界值为2.84和1.71μmol/L。PCys C/SCys C曲线下面积为0.865,95%可信区间0.692~1.000;PCys C曲线下面积为0.735,95%可信区间0.528~0.965。3在结核性胸腔积液中PCys C/SCys C的敏感度(60.3%)和准确度(80.2%),高于PCys C的敏感度(44.9%)和准确度(72.4%)。结论 PCys C/SCys C在结核性胸腔积液中表达优于PCys C,由此可见PCys C/SCys C可以做为诊断结核性胸膜炎一个指标应用于临床。
Objective To investigate the clinical value of cystatin C (Cys C) in the diagnosis of tuberculous pleurisy. Methods A total of 116 patients with tuberculous pleurisy (TB group) and 50 patients with hepatic hydrothorax (control group) were enrolled in 2014 from Handan Infectious Disease Hospital. Cys C, adenosine deaminase (ADA) Measurements were calculated pleural effusion and serum content ratio. Results 1 In both groups, PADA, SADA, SCys C, Cys C in pleural effusion and serum (PCys C / SCys C) and pleural effusion and serum ADA ratio (PADA / SADA), the difference was statistically significant (P <0.01). 2 In the tuberculosis group, the ROC curve was made based on the diagnosis of PADA / SADA> 2. According to the principle of maximum value of ROC curve “Sensitivity + Specificity ”, the critical values of PCys C / SCys C and PCys C were 2.84 and 1.71 μmol / L. The area under the curve of PCys C / SCys C was 0.865, the 95% confidence interval was 0.692-1.000, the area under the PCys C curve was 0.735, the 95% confidence interval was 0.528-0.965.3, and the level of PCys C / SCys C in tuberculous pleural effusion Sensitivity (60.3%) and accuracy (80.2%) were higher than that of PCys C (44.9%) and accuracy (72.4%). Conclusions PCys C / SCys C is superior to PCys C in tuberculous pleural effusions. Therefore, PCys C / SCys C can be used as an index in the diagnosis of tuberculous pleurisy.