Ji Qiaoying, Huang Bifei, Wang Maofeng, Ren Zhaoxiang, Zhang Sha, Zhang Yongjun, Sheng Lijian, Yu Yayao, Jiang Jinwen, Chen Debao, Ying Jun, Yu Jiong, Qiu Liuyi, Wan Rugen, Li Weimin
Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China.
Pathology Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China.
Exp Ther Med. 2014 Apr;7(4):778-784. doi: 10.3892/etm.2014.1503. Epub 2014 Jan 27.
Clinical history and physical examination are helpful in indicating the potential causes of pleural effusions (PEs). However, the accurate diagnosis and establishment of the causes of PE is an ongoing challenge in daily clinical practice. The primary aim of this study was to distinguish between infectious PE and malignant PE (MPE) by measuring two major acute phase response biomarkers: prealbumin (PA) and C-reactive protein (CRP). The study was a prospective trial involving 151 patients who were diagnosed with infectious PE or MPE. Patients with infectious PE were divided into two subgroups: tuberculous PE (TBPE) and parapneumonic PE (PNPE). A further 58 patients with PEs that showed no evidence of MPE, TBPE or PNPE were classified as the chronic non-specific PE (NSPE) group. Demographic characteristics and pleural fluids of the subjects were collected consecutively. The discriminative properties of pleural fluid routine biochemistries, and PA and CRP were evaluated. PA, CRP and classical fluid parameters were also applied to classify patients with infectious PE and MPE. Receiver operating characteristics (ROC) analysis established the cutoffs of PA and CRP for discriminating between groups. Pleural fluid PA levels were significantly higher in the MPE group (n=47) than in the infectious PE group (n=104). Pleural fluid CRP levels were significantly higher in the infectious PE group than in the MPE group. Pleural fluid PA levels were identified to be moderately negatively correlated with CRP levels in the MPE group, with a statistically significant correlation coefficient of -0.352. The ROC curve showed that the sensitivity and specificity of PA for the diagnosis of MPE were 0.851 and 0.548, respectively, at the cutoff of 28.3 mg/l. The area under the curve (AUC) was 0.784 (95% CI, 0.707-0.861). Using CRP as a diagnostic parameter resulted in an comparable AUC of 0.810 (95% CI, 0.736-0.885), at the cutoff of 35.2 mg/l. Combinations of PA and CRP resulted in incrementally discriminating values for MPE, with a sensitivity of 0.617 and a specificity of 0.903. The measurement of PA and CRP levels in pleural fluid may be a useful adjunctive test in PE, as a potential differentiator between infectious PE and MPE.
临床病史和体格检查有助于提示胸腔积液（PE）的潜在病因。然而，在日常临床实践中，准确诊断和明确PE的病因仍然是一项持续存在的挑战。本研究的主要目的是通过检测两种主要的急性期反应生物标志物：前白蛋白（PA）和C反应蛋白（CRP），来区分感染性PE和恶性PE（MPE）。该研究是一项前瞻性试验，纳入了151例被诊断为感染性PE或MPE的患者。感染性PE患者被分为两个亚组：结核性PE（TBPE）和类肺炎性PE（PNPE）。另外58例未显示MPE、TBPE或PNPE证据的PE患者被归类为慢性非特异性PE（NSPE）组。连续收集受试者的人口统计学特征和胸腔积液。评估胸腔积液常规生化指标以及PA和CRP的鉴别特性。PA、CRP和经典的积液参数也被用于对感染性PE和MPE患者进行分类。受试者工作特征（ROC）分析确定了用于区分各组的PA和CRP的临界值。MPE组（n = 47）的胸腔积液PA水平显著高于感染性PE组（n = 104）。感染性PE组的胸腔积液CRP水平显著高于MPE组。在MPE组中，胸腔积液PA水平与CRP水平呈中度负相关，相关系数为 -0.352，具有统计学意义。ROC曲线显示，在临界值为28.3 mg/l时，PA诊断MPE的敏感性和特异性分别为0.851和0.548。曲线下面积（AUC）为0.784（95% CI，0.707 - 0.861）。以CRP作为诊断参数，在临界值为35.2 mg/l时，AUC为0.810（95% CI，0.736 - 0.885），二者相当。PA和CRP联合使用对MPE的鉴别价值增加，敏感性为0.617，特异性为0.903。检测胸腔积液中PA和CRP水平可能是PE中一种有用的辅助检查，可作为感染性PE和MPE的潜在鉴别方法。
