胸腔积液肿瘤标志物对老年患者胸腔积液性质的鉴别诊断意义

Significance of tumor markers in the differential diagnosis of pleural effusion in elderly patients

目的探讨胸腔积液肿瘤标志物对老年患者胸腔积液性质的鉴别诊断意义。方法回顾性分析2012年7月至2019年7月浙江医院诊断并发胸腔积液的老年患者300例,其中恶性肿瘤性胸腔积液142例(恶性组),良性胸腔积液158例(良性组)。检测并比较两组患者胸腔积液及血清中的甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)、糖类抗原153(CA153)、糖类抗原724(CA724)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、乳酸脱氢酶(LDH)及胸腔积液腺苷脱氨酶(ADA)。组间比较采用非参数检验,绘制受试者工作特征曲线(ROC)分析各指标对胸腔积液良恶性的鉴别诊断价值。结果恶性组胸腔积液CA153、CA199、CA724、CYFRA21-1、CEA、NSE、AFP、LDH水平均高于良性组(Z=7.11、5.43、7.71、6.40、7.01、5.82、6.20、5.94,P<0.01)。ROC曲线分析显示,胸腔积液AFP、CEA、CA199、CA153、CA724、CYFRA21-1、NSE鉴别诊断胸腔积液良恶性的曲线下面积(AUC)均大于对应的血清肿瘤标志物。将胸腔积液CEA、CA724、CYFRA21-1、CA153、CA199、NSE、CA125、AFP截断值分别提高至7.50 ng/mL、3.20 U/mL、103 ng/mL、35 U/mL、30 U/mL、16 ng/mL、2880 U/mL、2.02 ng/mL时,其阳性预测值均得到不同程度提高,但敏感度均不同程度下降。结论大部分胸腔积液肿瘤标志物对老年性胸腔积液良恶性的鉴别诊断效能优于血清肿瘤标志物,可根据具体情况提高截断值辅助鉴别诊断。

Objective To explore the significance of tumor markers of pleural effusion in the differential diagnosis of benign and malignant pleural effusion in elderly patients.Methods A retrospective analysis was performed in 300 patients with pleural effusion in Zhejiang Hospital during July 2012 and July 2019,including 142 patients with malignant pleural effusion and 158 patients with benign pleural effusion.Alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigen(CA)125,CA199,CA153,CA724,soluble cytokeratin 19 fragment(CYFRA 21-1),neuron-specific enolase(NSE),lactate dehydrogenase(LDH)and adenosine deaminase(ADA)in pleural effusion and serum were detected.Non-parametric test was used to compare the difference of the above indexes between the two groups,and receiver operating characteristic(ROC)curve was used to analyze the value of each index in the differential diagnosis of benign and malignant pleural effusion.Results CA153,CA199,CA724,CYFRA21-1,CEA,NSE,AFP and LDH levels in pleural effusion were all higher in malignant group than in benign group(Z=7.11,5.43,7.71,6.40,7.01,5.82,6.20,5.94;P<0.01).ROC analysis showed the area under the curve(AUC)of AFP,CEA,CA199,CA153,CA724,CYFRA21-1 and NSE of pleural effusion were all greater than the corresponding serum tumor markers.High cut off values of pleural effusion CEA,CA724,CYFRA21-1,CA153,CA199,NSE,CA125 and AFP were set at 7.50 ng/mL,3.20 U/mL,103 ng/mL,35 U/mL,30 U/mL,16 ng/mL,2880 U/mL,2.02 ng/mL,respectivelies,the positive predictive values increased,but the sensitivities decreased.Conclusion Most tumor markers of pleural effusion are better than serum tumor markers in the differential diagnosis of benign and malignant pleural effusion in elderly patients.The cutoff value can be increased according to the specific situation to assist in the differential diagnosis.