摘要
目的探讨胸腔积液中微RNA-29a(miR-29a)和腺苷脱氨酶(ADA)联合检测诊断结核性胸膜炎的临床效能。方法选择2018年1月至2019年6月新乡医学院第一附属医院收治的142例胸腔积液患者为研究对象,根据原发病分为结核性胸腔积液(TPE)组(n=63例)和恶性胸腔积液(MPE)组(n=79例),TPE患者给予抗结核治疗方案治疗后根据有无胸膜增厚分为预后良好组和预后不良组。采用酶速率法检测胸腔积液中ADA水平,反转录聚合酶链反应(RT-PCR)检测胸腔积液中miR-29a的相对表达量。比较TPE组和MPE组患者胸腔积液中miR-29a和ADA表达水平,应用Spearman分析2组患者胸腔积液中miR-29a相对表达量与ADA水平的相关性,应用受试者操作特征(ROC)曲线分析胸腔积液中miR-29a、ADA单独及联合诊断TPE的临床效能;比较预后良好组和预后不良组TPE患者治疗前胸腔积液中miR-29a表达水平,使用ROC曲线分析TPE患者治疗前胸腔积液中miR-29a和ADA表达水平对治疗后出现胸膜增厚的临床诊断效能。结果TPE组患者胸腔积液中miR-29a相对表达量和ADA表达水平均显著高于MPE组(P<0.05)。TPE组胸腔积液中miR-29a与ADA存在显著正相关性(r=0.314,P>0.05),MPE组患者胸腔积液中miR-29a与ADA无明显相关性(r=0.234,P>0.05)。miR-29a诊断TPE的曲线下面积(AUC)为0.903[95%置信区间(CI):0.853~0.954],当截断值为0.46时,敏感度和特异度分别为90.50%和79.70%;ADA诊断TPE的AUC为0.840(95%CI:0.767~0.913),当截断值为18.63 U·L^(-1)时,敏感度和特异度分别为84.10%和74.70%;miR-29a联合ADA诊断TPE的AUC为0.943,敏感度和特异度分别为94.90%和92.40%。预后不良组患者治疗前胸腔积液中miR-29a相对表达量显著高于预后良好组(P<0.05),预后不良组与预后良好组患者胸腔积液中ADA表达水平比较差异无统计学意义(P>0.05)。治疗前胸腔积液中miR-29a相对表达量诊断TPE患者治疗后出现胸膜增厚的AUC为0.832(95%CI:0.727~0.939),当截断值为0.615时,敏感度和特异度分别为73.50%和78.60%;治疗前胸腔积液中ADA表达水平诊断TPE患者治疗后出现胸膜增厚的AUC为0.614(95%CI:0.432~0.795),当截断值为22.59 U·L^(-1)时,敏感度和特异度分别为46.28%和52.56%。结论胸腔积液中miR-29a联合ADA检测对结核性胸膜炎具有显著的临床诊断效能,miR-29a可作为诊断结核性胸膜炎患者抗结核治疗后出现胸膜增厚的标志物。
Objective To investigate the clinical efficacy of microRNA-29a(miR-29a)combined with adenosine deaminase(ADA)in pleural effusion for the diagnosis of tuberculous pleuritis.Methods A total of 142 patients with pleural effusion admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2018 to June 2019 were selected as the research objects,they were divided into the tuberculous pleural effusion(TPE)group(n=63)and malignant pleural effusion(MPE)group(n=63)according to the primary disease,and the patients in the TPE group were divided into the good prognosis group and poor prognosis group according to the incidence of pleural thickening after anti-tuberculosis treatment.The relative expression level of miR-29a and ADA level in pleural effusion of patients between the TPE group and MPE group were compared.The correlation between the relative expression level of miR-29a and ADA level in pleural effusion of patients in the two groups was analyzed by Spearman,the clinical efficacy of single and combination of miR-29a and ADA in pleural effusion for the diagnosis of TPE was analyzed by receiver operating characteristic(ROC)curve.The relative expression level of miR-29a and ADA level in pleural effusion of TPE patients before treatment were compared between the good prognosis group and poor prognosis group.The ROC curve was used to analyze the clinical diagnostic efficacy of relative expression level of miR-29a and ADA level in pleural effusion of TPE patients before treatment for pleural thickening after treatment.Results The relative expression level of miR-29a and ADA level in pleural effusion of patients in the TPE group were significantly higher than those in the MPE group(P<0.05).There was a significant positive correlation between miR-29a and ADA in pleural effusion of patients in the TPE group(r=0.314,P>0.05),there was no significant correlation between miR-29a and ADA in pleural effusion of patients in the MPE group(r=0.234,P>0.05).The area under the curve(AUC)of miR-29a in the diagnosis of TPE was 0.903[95%confidence interval(CI):0.853-0.954],when the cutoff value was 0.46,the sensitivity and specificity were 90.50%and 79.70%,respectively.The AUC of ADA in the diagnosis of TPE was 0.840(95%CI:0.767-0.913),when the cutoff value was 18.63 U·L^(-1),the sensitivity and specificity were 84.10%and 74.70%,respectively.The AUC of miR-29a combined with ADA in the diagnosis of TPE was 0.943,the sensitivity and specificity were 94.90%and 92.40%,respectively.The relative expression level of miR-29a in pleural effusion of patients with poor prognosis was significantly higher than that of patients with good prognosis before treatment(P<0.05),there was no significant difference in the expression level of ADA between patients with poor prognosis and patients with good prognosis(P>0.05).The AUC of miR-29a in pleural effusion before treatment for diagnosing pleural thickening after treatment was 0.832(95%CI:0.727-0.939),when the cutoff value was 0.615,the sensitivity and specificity were 73.50%and 78.60%,respectively;the AUC of ADA in pleural effusion before treatment for diagnosing pleural thickening after treatment was 0.614(95%CI:0.432-0.795),when the cutoff value was 22.59 U·L^(-1),the sensitivity and specificity were 46.28%and 52.56%,respectively.Conclusion The clinical diagnostic efficacy of miR-29a combined with ADA for tuberculous pleurisy is significant,miR-29a can be used as a marker for pleural thickening in patients with tuberculous pleurisy after anti-tuberculosis treatment.
作者
高景利
崔俊伟
石卓林
高远
贾睿岐
GAO Jingli;CUI Junwei;SHI Zhuolin;GAO Yuan;JIA Ruiqi(Department of Tuberculosis,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of General Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Respiratory Intensive Care Unit,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2021年第8期746-750,共5页
Journal of Xinxiang Medical University
基金
河南省医学科技攻关计划联合共建项目(编号:2018020344)
新乡医学院第一附属医院青年基金(编号:QN-2019-A06)。
