四项肿瘤标志物测定对癌性、结核性胸腔积液的鉴别诊断价值

The diagnostic value of measurement of 4 tumor markersin the patients with cancer and tuberculous pleural effusion

目的 :探讨癌胚抗原 (CEA)、糖类抗原 (CA199、CA12 5、CA15 3)对癌性和结核性胸腔积液的鉴别诊断价值。方法 :应用放射免疫法对 6 4例癌性胸腔积液、4 4例结核性胸腔积液及 2 0例健康人的血清、胸水进行观察。结果 :癌性胸腔积液患者血清和胸水CEA、CA199、CA12 5、CA15 3水平分别为 32 .4± 9.1、4 4 .5± 16 .4、39.6± 14 .2、34.7± 12 .3和 5 2 .6± 12 .1、6 2 .0±17.2、5 7.4± 13.2、5 6 .3± 10 .1,均显著高于健康对照组和结核性胸液组 ,且胸水 /血清比值 >1。CEA、CA199、CA12 5和CA15 3联合检测时敏感性、准确性及特异性均明显提高。其中CEA +CA199联合检测诊断癌性胸腔积液的敏感性为 92 .2 % ,特异性为 90 .9%。结论 :肿瘤标志物CEA、CA199、CA12 5及CA15 3联合检测对癌性和结核性胸腔积液的鉴别诊断有较好的临床价值 ,联合方式以CEA +CA199为佳。

Objective:To evaluate carcinoembryonic antigen(CEA),carbobydrate antigen(CA199、CA125 and CA153) in differential diagnosis of cancer and tuberctulous pleural effusion.Methods:The serum and pleural fluid levels of 4 tmnor markers in 64 patients with cancerous effusion,44 patients with tuberculous effusion and 20 normal subjects were measured using immunoradiometric assay.Results:The serum and pleural fluid levels of CEA,CA199,CA125 and CA153 in the patients with cancerous effusion were significantly higher than in those with tuberculous effusion with a ratio>1.Assessing CEA,CA199,CA125,CA153 could significantly increase the sensitivity and specificity.The sensitivity of combined assay with serum CEA+CA199 in diagnosing malignant pleural effusion was 92.2%,and the specificity was 90.9%.Conclusion:Tumor markers of CEA,CA199,CA125 and CA153 have high clinical values in differential diagnosis of cancerous and tuberculous pleural effusion.The combined assay with CEA+CA199 should be recommended.