摘要目的　研究结核性及恶性胸腔积液患者胸液及血清中肿瘤坏死因子（TNF）、白细胞介素8（IL-8）、胸液中可溶性细胞间粘附分子1（sICAM-1）及外周血多形核白细胞（PMN）上粘附分子CD11b/CD18在参与胸膜病变的病理生理过程中的作用和在鉴别诊断上的价值。方法　采用放射免疫分析法（RIA法）、双抗体夹心ELISA法以及流式细胞仪技术，检测31例结核性、31例恶性胸腔积液患者胸液和(或)血清中TNF、IL-8、sICAM-1和CD11b/CD18表达水平，并与31例健康献血者对照。结果　结核性和恶性胸腔积液患者血清中TNF、IL-8含量以及PMN上CD11b/CD18表达显著高于正常对照组（P<0.01），结核性胸液中TNF与IL-8水平和血PMN上CD11b/CD18表达明显高于恶性胸液患者（P<0.01），结核性胸液中sICAM-1水平明显低于恶性胸液（P<0.01）。胸腔积液中TNF与IL-8、sICAM-1水平呈显著正相关（r=0.74和r=0.79，P<0.01），血清TNF与PMN上CD11b/CD18的表达呈显著正相关（r=0.61，P<0.01），胸腔积液中sICAM-1水平与血PMN上CD11b/CD18的表达呈显著负相关（经作曲线拟合，Y=1442.31-36.85X+0.25X2，R2=0.59，F=19.83，P<0.01）。结论　细胞因子TNF、IL-8和粘附分子sICAM-1、CD11b/CD18相互联系，在结核和肿瘤性胸膜病变的免疫病理生理过程中起着重要作用。它们在结核性和肿瘤性胸腔积液患者的表达水平不同，可作为临床上鉴别诊断的参考指标。

abstractsObjectives　To explore the significance of TNF, IL-8, sICAM-1 and CD11b/CD18 in pleural effusions and/or in peripheral blood in formation of pleural effusions and the possible role in differential diagnosis. Methods　Levels of TNF, IL-8, sICAM-1 and PMN CD11b/CD18 expression were measured by radioimmunoassay (RIA), enzyme-linked immunosorbent assay (ELISA) and flow cytometry (FCM). 31 patients with tuberculous pleural effusions, 31 malignant pleural effusions and 31 healthy persons as control were studied.Results　The serum levels of TNF, IL-8 and PMN CD11b/CD18 expression in benign and malignant effusions were markedly higher than those in controls (P<0.01). The levels of TNF, IL-8 and PMN CD11b/CD18 in patients with tuberculous pleural effusions were elevated higher than those with malignant effusions (P<0.01). The levels of sICAM-1 in pleural effusions were much lower in tuberculosis than malignancy (P<0.01). TNF levels in pleural effusions were positively correlated to the IL-8 and sICAM-1 levels (r=0.74 and 0.79, respectively, P<0.01). TNF levels in serum was positively correlated to the PMN CD11b/CD18 expression (r=0.61, P<0.01), but the latter was negatively correlated to sICAM-1 levels of pleural effusions (Y=1442.31-36.85X+0.25X2，R2=0.59，F=19.83，P<0.01). Conclusions　The results show that TNF, IL-8, sICAM-1 and CD11b/CD18 may work and affect each other in immunopathological process of tuberculous and malignant pleural effusions. The changes of TNF, IL-8 in pleural effusions and the expressions of PMN CD11b/CD18 are of clinically diagnostic value in distinguishing tuberculous from malignant pleural effusions.