可溶性指标对于胸腔积液鉴别诊断价值施焕中

可溶性指标对于胸腔积液鉴别诊断价值施焕中AnnInternMed1972;77:507-5132015-5-18Causen(%)Causen(%)Benigndiseases429(51.5)Malignancies342(41.1)Tuberculosis333(77.6)Metastaticcancers272(79.5)Bacterialinfection36(8.4)Mesothelioma35(10.2)Chylothorax6(1.4)Lymphoma10(2.9)Chemicalpleurisy4(0.9)Undetermined25(7.3)Otherexudates33(7.7)Undiagnosed62(7.4)Transudates17(4.0)Causedistributionofpleuraleffusions(n=833)Chest2015;147:1395-1400系统评价多种肿瘤标志物对于鉴别诊断恶性胸腔积液的临床价值，不能依靠单独或联合检测多种肿瘤标志物确诊恶性胸腔积液，但联合检测多种指标的敏感度高于其中的任一种。Thorax2008;63:35-41.目前尚无证据表明单一肿瘤标志物可用于诊断MPE。RespirMed2010;104:149-156.间皮素诊断恶性胸膜间皮瘤的敏感度、特异度、阳性似然比、阴性似然比分别为64%、89%、7.10、0.39。Figure1:ImagestakenfrompatientswithtuberculouspleurisyusingmedicalthoracoscopeshowingA)tuberculousnoduleswithirregulardistributiononparietalpleura;B)tuberculousnodulesonparietal(upper)andvisceral(bottom)pleura;C)multiplemilitarytuberculousnodulesonparietalpleura;D)diffusedparietalpleuranodulesandpleuraladhesions;E)parietalpleuralhyperemiawithnecrosisofthepleuralnode;F)parietalpleuralhyperemiawithwhitepleuralplaques.Figure2:Representativetuberculosispathologyseeninpleuralbiopsyspecimenfromtwopatientswithtuberculouspleuraleffusion.A)epithelioidcellgranulomasareseenontheparietalpleurat;B)aacid-fastbacillus(arrow)isseenwithinthegranulomas;C)theviewshowsthepresenceofcaseatingnecrosisintheparietalpleurawithscatteredmultinucleatedgiantcells;D)aacid-fastbacillus(arrow)isseenwithinthecaseatingnecrosis.PanelsAandC,hematoxylinandeosinstaining;originalmagnification:×200.PanelsBandD,Ziehl-Neelsenstaining;originalmagnification:×400.PanelsAandBaretakenfromthesamepatient;PanelsCandDaretakenfromanotherpatient.系统评价IFN-γ和腺苷脱氨酶等对于诊断结核性胸膜炎的临床价值，显示IFN-γ和腺苷脱氨酶是诊断结核性胸膜炎的可靠指标，为临床应用这些诊断指标提供确切的循证医学依据。Chest2007;131:1133-1141.IF=7.132,他引66次IFN-γ诊断TPE的敏感度、特异度、阳性似然比、阴性似然比分别为89%、97%、23.45、0.11。RespirMed2008;102:744-754.IF=2.917,他引69次ADA诊断TPE的敏感度、特异度、阳性似然比、阴性似然比分别为92%、90%、9.03、0.10。EurRespirJ2005;25:605–611ClinCancerRes2009;15:2231-2237JImmunol2010;185:6348-6354Chest2007;131:1133-1141RespirMed2008;102:744-754PLoSONE2012;7:e40450PLoSONE2012;7:e40450ChinMedJ2013;126:3215-3221中华医学杂志2014;94:2641-2644RespirCare2014;59:399–405PLoSONE2012;7:e40450Tuberculosis2014;94:579-588Tuberculosis2014;94:579-588Tuberculosis2014;94:579-588Tuberculosis2014;94:579-588人有了知识，就会具备各种分析能力，明辨是非的能力。所以我们要勤恳读书，广泛阅读，古人说“书中自有黄金屋。