| Objective:To investigate the value of the Leptin,tumor necrosis factor-a(TNF-α),carcino-embryonic antigen (CEA) in fluid and serum in the differential diagnosis of tuberculous and malignant pleural effusion.Methods:Serum and pleural fluid specimens were simultaneously collected from 40 patients (benign tuberculous 20, malignant 20),besides 20 healthy controls.Leptin,TNF-αcontents were determined by ELISA,and CEA contents were determined by chemoluminescece.Result:1.Serum Leptin in patients with tuberculous and malignant pleural effusion were lower than those in controls(P=0.000,P=0.031),Serum Leptin in patients with tuberculous effusion was lower than that in patients with malignant pleural effusion(P=0.009), pleural fluid Leptin in tuberculous effusion patients was lower than that in the malignant pleural effusion patients(P=0.04),Serum Leptin in both the tuberculous effusion and malignant patients were lower than pleural fluid Leptin in both groups (P=0.034,P=0.016).2.Serum TNF-αin patients with tuberculous effusion was lower than those in patients with malignant pleural effusion(P=0.042),Serum TNF-αin patients with tuberculous and malignant pleural effusion were higher than that in controls(P= 0.037,P=0.000),pleural fluid TNF-αin the tuberculous effusion patients was higher than that in the malignant pleural effusion patients(P=0.007)3.Serum CEA in the tuberculous effusion patients and controls were lower than that in the malignant pleural effusion patients (P=0.008,P=0.009),pleural fluid CEA in the tuberculous effusion patients was lower than that in the malignant pleural effusion patients(P=0.000),but there was no difference in Serum CEA betwere the tuberculous effusion patients and controls(P=0.996)4.The sensitivity of Serum and pleural fluid Leptin single-positive were improved from 80%,70% to 90%, The specificity of Serum and pleural fluid Leptin both-positive were improved from 80%,80% to 95%.The sensitivity of Serum and pleural fluid TNF-a single-positive were improved from 45%,65% to 85%,The specificity of Serum and pleural fluid TNF-a both-positive were improved from 80%,65% to 90%.The sensitivity of Serum and pleural fluid CEA single-positive were improved from 40%,75% to 80%,there were absolute difference between combined detection and single detection(P<0.05);The specificity of Serum and pleural fluid CEA both-positive were improved from 90%,90% to 95%,but there were no difference between combined detection and single detection(P>0.05).5.In parellel tests of the three groups (pleural fluid):The sensitivity of Leptin+TNF-αwas 89.5%,and the specificity was 52%.The sensitivity of Leptin+ CEA was 92.5%,and the specificity was 70%.The sensitivity of TNF-α+ CEA was 91%,and the specificity was 58.5%,The sensitivity of Leptin+TNF-α+ CEA was 95%,and the specificity was 46.08%, there were absolute difference between combined detection and single detection(P<0.05).In serial tests of the three groups(pleural fluid).In serial tests of the three groups(pleural fluid):The sensitivity of Leptin+ TNF-αwas 45.5%,and the specificity was 93%.The sensitivity of Leptin+ CEA was 56%,and the specificity was 98%. The sensitivity of TNF-α+ CEA was 49%,and the specificity was 96.5%,The sensitivity of Leptin+TNF-α+ CEA was 34.13%,and the specificity was 99%, there were absolute difference between combined detection and Leptin,TNF-a single detection(P<0.05).Conclusion:Serum Leptu,TNF-α,CEA,and the pleural fluid Leptin,CEA in the patients with malignant pleural effusion were higher than those in the tuberculous effusion patients, so serum and the pleural fluid Leptin,TNF-α,CEA were important indicators to detect the tuberculous and malignant pleural effusion.The Leptin,TNF-α,CEA serum and pleural fluid respectively combined detection and the Leptin,TNF-α,CEA pleural fluid combined detection could surpass single detection, the Leptin,TNF-α,CEA combined detection was helpfu to diagnose tuberculous and malignant pleural effusion.
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