可溶性指标对于胸腔积液鉴别诊断的价值-施焕中

可溶性指标对于胸腔积液鉴别诊断的价值首都医科大学附属北京朝阳医院北京呼吸疾病研究所施焕中AnnInternMed1972;77:507-5132015-5-18RespirationDOI:10.1159/000435962Causen(%)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)RespirationDOI:10.1159/000435962Chest2015;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。RespirMed2015;doi:10.1016/j.rmed.2015.06.008Figure1:ImagestakenfrompatientswithtuberculouspleurisyusingmedicalthoracoscopeshowingA)tuberculousnoduleswithirregulardistributiononparietalpleura;B)tuberculousnodulesonparietal(upper)andvisceral(bottom)pleura;C)multiplemilitarytuberculousnodulesonparietalpleura;D)diffusedparietalpleuranodulesandpleuraladhesions;E)parietalpleuralhyperemiawithnecrosisofthepleuralnode;F)parietalpleuralhyperemiawithwhitepleuralplaques.RespirMed2015;doi:10.1016/j.rmed.2015.06.008Figure2: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.RespirMed2015;doi:10.1016/j.rmed.2015.06.008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;15:2231-2237JIm