本文選題：胸水膽固醇 + 滲出液　； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:探討胸水膽固醇(Pch)、胸水膽固醇與血清膽固醇的比值(P/Sch)在判定胸腔積液滲、漏出液性質(zhì)及胸水良、惡性中的應(yīng)用價(jià)值。方法:收集2014年12月至2016年12月因胸腔積液在延安大學(xué)附屬醫(yī)院住院治療病例資料,在患者入院后3天內(nèi)行胸膜腔穿刺術(shù)進(jìn)行胸水標(biāo)本的采集、入院次日清晨空腹采集血清標(biāo)本,送檢胸水常規(guī)、胸水生化、Pch及Sch。然后進(jìn)一步計(jì)算出P/Sch。Pch、P/Sch分別按性別、年齡段、胸水的滲漏性質(zhì)、胸水的病因進(jìn)行分組比較,若對胸水滲漏性質(zhì)及胸水良惡性質(zhì)的鑒別有意義時(shí),進(jìn)一步分析制作受試者工作特征曲線(ROC曲線),并計(jì)算出其診斷界值、敏感度、特異度。結(jié)果:本次研究共收集221例胸腔積液病例,45歲以下(~45)的63例,45~65歲之間(45~65)的72例,65歲以上(65~)的有86例;惡性胸水61例,良性胸水160例(結(jié)核84例、肺炎18例、心源性53例、肝源性2例、腎源性3例);滲出液155例,漏出液52例,界于滲漏之間14例。1.惡性胸水和良性胸水在三個(gè)年齡段(~45、45~65、65~)分布的差異存在統(tǒng)計(jì)學(xué)意義(P0.05);良性胸水在~45、45~65的比例高于65~,惡性胸水在~45、45~65的比例低于65~(P0.05)。2.滲出性與漏出性胸水中Pch(2.55±0.08 vs.0.86±0.41,P0.05)、P/Sch(0.63±0.19vs.0.24±0.18,P0.05)的差異均有統(tǒng)計(jì)學(xué)意義,滲出液中Pch、P/Sch要顯著高于漏出液。3.Pch、P/Sch在鑒別胸水滲漏性質(zhì)中的診斷效能顯示,Pch、P/Sch分別以1.72、0.41為診斷界值,特異度分別為0.99、0.98,敏感度分別為0.97、0.99,ROC中的曲線下面積分別為0.97、0.98。4.惡性胸水中男、女性Pch(2.78±0.86 vs.2.64±1.30,P0.05)、P/Sch(0.68±0.16 vs.0.63±0.11,P0.05)差異均無統(tǒng)計(jì)學(xué)意義;良性胸水中男、女性Pch(2.68±0.36vs.2.61±0.42,P0.05)、P/Sch(0.53±0.12 vs.0.56±0.14,P0.05)差異均無統(tǒng)計(jì)學(xué)意義。5.~45、45~65歲的患者中惡性、結(jié)核性、肺炎性胸水Pch、P/Sch的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。6.65~歲的患者中惡性、結(jié)核性、肺炎性胸水的Pch(2.94±0.61 vs.2.29±0.53 vs.2.31±0.40,P0.05)、P/Sch(0.73±0.10 vs.0.60±0.19 vs.0.61±0.11 P0.05)差異有有統(tǒng)計(jì)學(xué);進(jìn)一步行兩兩比較,結(jié)果示惡性胸水P/Sch、Pch水平要高于結(jié)核性、肺炎性胸水(P0.05),結(jié)核性胸水P/Sch、Pch與肺炎性胸水差異無統(tǒng)計(jì)學(xué)意義(P0.05)。7.老年(65~)滲出性胸水患者中Pch與Sch不存在線性相關(guān)。8.Pch、P/Sch鑒別老年胸水良惡性質(zhì)中的診斷效能分析,結(jié)果顯示Pch、P/Sch在ROC中的曲線下面積分別為0.74、0.76,Pch的診斷界值為3.18,特異度為0.88,敏感度為0.78;P/Sch的診斷界值為0.71,特異度為0.83,敏感度為0.77。結(jié)論:1.Pch、P/Sch在判定胸腔積液滲漏性質(zhì)中具有一定的診斷價(jià)值,靈敏度、特異度均較高。2.Pch、P/Sch在鑒別胸腔積液良惡性質(zhì)中,65歲以下的患者未發(fā)現(xiàn)有應(yīng)用價(jià)值,在65歲以上的患者中有一定的參考價(jià)值。
[Abstract]:Objective: to investigate the value of pleural effusion cholesterol (Pch), the ratio of pleural effusion cholesterol to serum cholesterol (P / Sch) in the diagnosis of pleural effusion, the nature of effusion and the benign and malignant pleural effusion. Methods: the data of patients with pleural effusion were collected from December 2014 to December 2016 in the affiliated Hospital of Yan'an University. Pleural puncture was performed within 3 days after admission to collect pleural effusion samples. Serum samples were collected on an empty stomach the next day after admission. Pleural effusions were examined for routine, biochemistry, Pch and Sch. Then we further calculated that P / Sch.Pchn / P / Sch was divided into two groups according to sex, age, hydrothorax leakage, and the etiology of pleural effusion. If it is meaningful to distinguish the effusion from the benign and malignant characteristics of pleural effusion, Furthermore, the operating characteristic curve (ROC curve) was made and its diagnostic threshold, sensitivity and specificity were calculated. Results: a total of 221 cases of pleural effusion were collected in this study. Among the 221 cases of pleural effusion under 45 years old (45 years old), there were 63 cases between 45 and 65 years of age (65 ~ 65 years old), 61 cases of malignant pleural effusion and 160 cases of benign pleural effusion (84 cases of tuberculosis, 18 cases of pneumonia, 53 cases of cardiogenic disease), 86 cases of malignant pleural effusion and 160 cases of benign pleural effusion (84 cases of tuberculosis, 18 cases of pneumonia and 53 cases of cardiogenic disease). Hepatogenic 2 cases, kidney 3 cases), exudate 155 cases, leakage 52 cases, between leakage 14 cases. The distribution of malignant pleural effusion and benign pleural effusion in three age groups was statistically significant (P0.05), the proportion of benign pleural effusion was higher than 65%, and the proportion of malignant pleural effusion was lower than 65 ~ (P0.05) .2. The difference of Pch between effusion (2.55 鹵0.08 vs.0.86 鹵0.41g) and effusion (0.63 鹵0.19vs.0.24 鹵0.18p0.05) was statistically significant. The diagnostic efficacy of PchG / P / Sch in effusion was significantly higher than that in effusion .3.The diagnostic efficacy of Pch / Sch in distinguishing the leakage of pleural effusion showed that the diagnostic limit value of Pch / Sch was 1.72 / 0.41, respectively. The specificity and sensitivity of ROC were 0.99 and 0.98, respectively. The area under the curve of ROC was 0.97 ~ 0.98.4, respectively. There was no significant difference between male and female Pch (2.78 鹵0.86 vs.2.64 鹵1.30p0.05) in malignant pleural effusion (0.68 鹵0.16 vs.0.63 鹵0.11p0.05), but there was no significant difference between male and female in benign pleural effusion (2.68 鹵0.36vs.2.61 鹵0.42p0.05) and Pp-Sch (0.53 鹵0.12 vs.0.56 鹵0.14p0.05). There was no significant difference of Pch / Sch in pneumonic pleural effusion (P0.05) .6.65 ~ year old patients with malignant, tuberculous and pneumonic pleural effusion (2.94 鹵0.61 vs.2.29 鹵0.53 vs.2.31 鹵0.40P05). There was a significant difference in P / Sch between malignant pleural effusion and tuberculous pleural effusion (0.73 鹵0.10 vs.0.60 鹵0.19 vs.0.61 鹵0.11 P0.05), the results showed that the level of Pch in malignant pleural effusion was higher than that in tuberculous pleural effusion. Pneumonic pleural effusion (P0.05), tuberculous pleural effusion P / S Schnn Pch and pneumonic pleural effusion had no significant difference (P0.05). 7. There was no linear correlation between Pch and Sch in the elderly patients with effusion. 8. The diagnostic efficacy of Pch / Sch in differentiating benign and malignant characteristics of senile pleural effusion. The results showed that the area under the curve of Pchchon P / Sch in ROC was 0.74 鹵0.76 and the diagnostic threshold value was 3.18, the specificity was 0.88, the sensitivity of 0.78 P / Sch was 0.71, the specificity was 0.83 and the sensitivity was 0.77. Conclusion: 1. Pchchon P / Sch has certain diagnostic value in determining pleural effusion leakage. The sensitivity and specificity are higher. 2.Pchchon P / Sch has no application value in differentiating benign and malignant pleural effusion patients under 65 years old. It has certain reference value in patients over 65 years old.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R561.3

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本文編號(hào)：2072336