| Objective: to detect the expression of VCAM-1 in serum and pleural effusion,and to explore the clinical value of VCAM-1 in tuberculous pleurisy.Methods: Collecting 87 patients' s pleural effusion prospectively,including 49 patients with tuberculous pleurisy(TPE),13 patients with malignant pleural effusion(MPE),8 patients with parapneumonic pleural effusion(PPE)and 17 patients with leakage pleural effusion(control).The pleural effusion was collected by thoracentesis in 87 patients,and the serum samples were collected by vacuum blood sampling.The expression of VCAM-1 was detected by enzyme-linked immunosorbent assay(ELISA)in the pleural effusion and serum samples of different groups of patients.The leukocytes in the pleural effusion samples were classified and counted.Compared and analyzed VCAM-1,ADA,LDH and the expression difference and correlation of leukocyte count in pleural fluid and serum in different types of pleural effusion.And the diagnostic value of VCAM-1,ADA,LDH and leukocyte count in tuberculous pleurisy were analyzed by ROC curve.Results: 1.In TPE group(609.0±331.2,ng/ml),PPE group(472.6 ±116.9,ng/ml)and control group(354.8±99.4,ng/ml),the concentration of VCAM-1 in pleural effusion was significantly higher than that in control group(P<0.05);in TPE group,the concentration of VCAM-1 was significantly higher than that in serum(609.0±331.2,ng/ml vs.462.7± 219.5),The difference was statistically significant(P<0.05);2.The percentage of lymphocyte in pleural effusion of TPE group(80.9 ± 11.5%)was significantly higher than that of control group(59.7 ± 17.3%)(P< 0.001).The difference between TPE group and MPE group was statistically significant(P< 0.05).In TPE group,the percentage of lymphocyte in pleural effusion and that in serum were compared(80.5 ± 18.3% vs.10.0 ± 4.7%).The expression level in pleural effusion was significantly higher than that in serum(P< 0.0001);3.The levels of ADA in TPE group(68.4±43.8,IU/L),MPE group(14.6±7.1,IU/L),PPE group(41.5± 22.6,IU/L)and control group(4.4 ± 3.1,IU/L)were significantly higher than those in the three groups(all P<0.001);in serum,the levels of ADA in TPE group and MPE group were significantly higher(20.4±7.8,IU/L vs.13.1±2.6,IU/L),with statistical significance(P< 0.001);4.LDH in 385.5 [274.3-593.5] U/L,404.0 [323.5-555.5] U/L and 1066.5 [436.8-2088.8] U/Lof TPE group was significantly higher than that in control group111.0 [79.0-169.0] U/L,with statistical significance(P < 0.001);4.In pleural effusion,there was a positive correlation between VCAM-1 level and lymphocyte percentage in four groups(r = 0.330,P < 0.01);there was a positive correlation between VCAM-1 level and ADA level in four groups(r=0.300,The correlation was statistically significant(P<0.01);ADA level was positively correlated with lymphocyte percentage in all subjects(r=0.330,P<0.01);ADA level was moderately positively correlated with LDH level in all subjects(r=0.680,P<0.001);VCAM-1 level in TPE group was positively correlated with lymphocyte percentage in pleural water The correlation was statistically significant(r =0.300,P=0.045).5.According to ROC curve,the cut-off value of VCAM-1 in pleural effusion in this experiment is 468.5ng/ml,and its sensitivity in the diagnosis of tuberculous pleurisy is 71%,and its specificity is 73%,AUC = 0.790;ADA in pleural effusion has a high specificity and sensitivity in the diagnosis of tuberculous pleurisy,and its sensitivity is 91%,and its specificity is 82%,AUC=0.920;LDH in pleural effusion has a good sensitivity in the diagnosis of tuberculous pleurisy The sensitivity is 95%,but the specificity is low,only 35%,AUC=0.630;the sensitivity of the percentage of lymphocytes in the pleural water to tuberculous pleurisy is high,93%,the specificity is slightly poor,just 70%.The sensitivity of VCAM-1 in serum to the diagnosis of tuberculous pleurisy is not satisfactory,only 40%,the specificity is 94%,AUC= 0.600.Conclusion: In this experiment,the level of VCAM-1 in pleural effusion and the percentage of lymphocytes in pleural effusion were increased significantly,and VCAM-1 was positively correlated with the ratio of lymphocytes in pleural effusion,but the level of VCAM-1 in serum was not significantly increased.It can be seen that VCAM-1 in pleural effusion has a certain value for the clinical diagnosis of tuberculous pleurisy. |
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