本文選題：內(nèi)科胸腔鏡 + γ-干擾素釋放試驗�。� 參考：《河北大學(xué)》2017年碩士論文

【摘要】：目的:研究外周血、胸腔積液γ-干擾素釋放試驗(Interon-gama Release Assays.IGRAs)和血清、胸腔積液IL-6(Interleukin-6.IL-6)水平檢測對于鑒別結(jié)核性與惡性胸腔積液的臨床價值。方法:對在2015-7至2016-12期間于我院呼吸科住院的106例滲出性胸腔積液患者行內(nèi)科胸腔鏡檢查。根據(jù)其病理結(jié)果,排除不符合標(biāo)準(zhǔn)的病例,最終納入結(jié)核性胸膜炎(Tuberculous pleural effusion.TPE)患者49例和惡性胸腔積液(Malignant pleural effusion.MPE)患者37例。對納入患者的T-SPOT.TB和IL-6檢測的結(jié)果進行收集、統(tǒng)計。對T-SPOT.TB檢測和IL-6檢測的結(jié)果進行組間和組內(nèi)比較,以測得兩組間檢測指標(biāo)的水平差異。繪制受試者工作特征曲線(ROC曲線),根據(jù)曲線下面積比較各個檢測指標(biāo)的診斷效能。并且測得最佳診斷臨界值,計算靈敏度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值以評估診斷指標(biāo)的臨床應(yīng)用價值。結(jié)果:1.TPE組外周血、胸腔積液的T-SPOT.TB的斑點形成細(xì)胞(SFC,Spots forming cell)數(shù)量均明顯高于MPE組,并且,TPE組胸腔積液的SFC數(shù)量明顯高于外周血的SFC數(shù)量,差異均具有統(tǒng)計學(xué)意義。2.TPE組血清、胸腔積液中的IL-6水平均高于MPE組。并且,TPE組胸腔積液中的IL-6水平明顯高于血清IL-6水平,差異均具有統(tǒng)計學(xué)意義。3.外周血、胸腔積液T-SPOT.TB、IL-6水平的ROC曲線下面積分別為0.709、0.910、0.660、0.875,胸腔積液T-SPOT.TB、IL-6水平檢測的診斷價值最高,其靈敏度、特異度、準(zhǔn)確率、最佳臨界值分別為85.7%、81.1%、83.7%、217/2.5×105,85.7%、78.4%、82.6%、226pg/ml。4.胸腔積液T-SPOT.TB與胸腔積液IL-6平行聯(lián)合檢測時的敏感度、特異度是91.8%、62.1%,其敏感度較兩項單獨檢測無明顯統(tǒng)計學(xué)意義(2c=1.33,P=0.25;X~2=1.33,P=0.25),系列聯(lián)合檢測時的敏感度和特異度分別為79.6%、97.3%。其特異度與T-SPOT.TB和IL-6相比均升高,差異具有統(tǒng)計學(xué)意義(X~2=4.17,P=0.04;X~2=5.14,P=0.02)。結(jié)論:1.利用內(nèi)科胸腔鏡可以直視不同類型胸腔積液患者胸膜的形態(tài)學(xué)的改變,內(nèi)科胸腔鏡術(shù)是一項直觀、高效、安全的檢測技術(shù),值得被廣泛推廣應(yīng)用。2.T-SPOT.TB、IL-6水平檢測對鑒別結(jié)核性和惡性胸腔積液均具有一定的應(yīng)用價值,其中,胸腔積液T-SPOT.TB、IL-6檢測的應(yīng)用價值更高。兩項檢測系列聯(lián)合對疾病的排除意義更大,T-SPOT.TB、IL-6水平檢測及兩項檢驗聯(lián)合檢測可以在臨床上作為輔助檢測手段.3.T-SPOT.TB的價格較高、技術(shù)要求高,基層醫(yī)院及偏遠(yuǎn)平困地區(qū)人群應(yīng)用可能會受到限制。
[Abstract]:Objective: to study the clinical value of Interon-gama release Assays.IGRAsand serum and IL-6 interleukin-6.IL-6 in peripheral blood and pleural effusion for differential diagnosis of tuberculous and malignant pleural effusion. Methods: 106 patients with exudative pleural effusion were examined by internal thoracoscopy during the period of 2015-7 to 2016-12. According to the pathological results, 49 cases of tuberculous pleural effusion.TPE and 37 cases of malignant pleural effusion pleural effusion.MPE) were excluded. The results of T-SPO T.TB and IL-6 were collected and counted. The results of T-SPOT.TB and IL-6 were compared between groups and within groups. The ROC curve was drawn and the diagnostic efficiency of each index was compared according to the area under the curve. The best diagnostic critical value, computational sensitivity, specificity, accuracy, positive predictive value and negative predictive value were obtained to evaluate the clinical application value of the diagnostic index. Results 1. The number of T-SPOT.TB forming cells in peripheral blood and pleural effusion in TPE group was significantly higher than that in MPE group, and that in TPE group was significantly higher than that in peripheral blood group (P < 0.05). The level of IL-6 in pleural effusion was higher than that in MPE group. The level of IL-6 in pleural effusion in TPE group was significantly higher than that in serum, and the difference was statistically significant. The areas under the ROC curve of T-SPOT.TBU IL-6 in peripheral blood and pleural effusion were 0.709 / 0.910 / 0.660,0.875, respectively. The diagnostic value, sensitivity, specificity, accuracy and the best critical value of T-SPOT.TBU IL-6 level in pleural effusion were 85.71.1and 83.71.21% 2172.5 脳 105.7mg / ml, 82.6pgml.4respectively. The sensitivity of parallel combined detection of T-SPOT.TB and IL-6 in pleural effusion was 91.80.The sensitivity of T-SPOT.TB and IL-6 in pleural effusion was 91.80.The sensitivity of T-SPOT.TB and IL-6 in pleural effusion was not statistically significant compared with that of two tests alone. The sensitivity and specificity of the series of combined tests were 79.6m7.3g. Compared with T-SPOT.TB and IL-6, the specificity was significantly higher than that of T-SPOT.TB and IL-6, and the difference was statistically significant. Conclusion 1. The morphologic changes of pleura of patients with different types of pleural effusion can be directly observed by internal thoracoscopy, which is an intuitionistic, efficient and safe detection technique. It is worthy to be widely used. 2. The detection of IL-6 in T-SPOT.TBU has a certain application value in differentiating tuberculous and malignant pleural effusion, among which, the detection of T-SPOT.TBOIL-6 in pleural effusion is more valuable in the diagnosis of tuberculous and malignant pleural effusion. The combination of two test series is of greater significance to the elimination of diseases. The detection of IL-6 level of T-SPOT.TBU and the combined detection of two tests can be used as a means of assistant detection in clinic. 3. The price of T-SPOT.TB is relatively high, and the technical requirements are high. Basic-level hospitals and remote poor areas may be restricted in the use of the population.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R521.7;R730.43

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