胸液糖链抗原153测定对胸腔积液鉴别诊断价值的研究

The values of CA153 detection in the differential diagnosis of pleural effusion.

目的 探讨胸液糖链抗原 15 3(CA15 3)测定在良、恶性胸腔积液鉴别诊断中的临床价值。方法 采用全自动化学发光免疫分析技术对 35例恶性、33例良性胸腔积液患者进行血清及胸液CA15 3测定 ,并与同时测定胸液中的癌胚抗原 (CEA)和肿瘤细胞及闭式经皮胸膜活检方法进行对比分析。结果 在良、恶性胸腔积液患者中胸液CA15 3含量分别为 (2 3.1± 10 .3)kU/L和 (6 1.7± 4 0 .6 )kU/L ,两者比较有显著差异 (P<0 .0 0 5 ) ;在恶性胸腔积液患者中胸液和血清CA15 3含量分别为 (6 1.7± 4 0 .6 )kU/L和 (4 1.5± 2 3.1)kU/L ,两者比较有显著差异 (P <0 .0 1) ;胸液中CA15 3、CEA、肿瘤细胞测定和胸膜活检 4种检测方法在恶性胸腔积液患者中的阳性率分别为 6 8.0 % ,70 .7% ,4 6 .7%和 6 6 .7% ;在恶性胸腔积液患者诊断中的敏感度分别为 6 0 .0 % ,6 5 .7% ,4 2 .9%和 5 7.1% ;特异度分别为 90 .9% ,84 .8% ,10 0 %和 10 0 % ;Yonden指数分别为 0 .5 0 9,0 .5 0 5 ,0 .4 2 9和 0 .5 71;以上 4种检测方法联合检测 (并联实验 )可明显提高其诊断的敏感度、诊断准确性和Yonden指数。结论 胸液CA15 3测定在胸腔积液鉴别诊断中不失为一种无创、简便、实用。

Objective To study the clinical value of the hydrothorax carbohydrate antigen 153(CA153)in the differential diagnosis of benign and malignant pleural effusion. Methods The serum and hydrothorax levels of CA153 were detected in 35 patients with malignant pleural effusion and 33 patients with benign pleural effusion, which were compared with the levels of hydrothorax carcinoma eryonicantigen(CEA), hydrothorax tumor cells, and blind pleural biopsy simultaneously. Results In both two groups, the concentration of CA153 were (23.1±10.3)kU/L and (61.7±40.6)kU/L respectively, with significant difference. The concentration of hydrothorax and serum CA153 in the malignant group were (61.7±40.6)kU/L and (41.5±23.1)kU/L, with significant difference. The positive rates of hydrothorax CA153, CEA, tumor cells detection and pleural biopsy in the patients with malignant pleural effusion were 68.0%,70.7%,66.7% and 46.7% respectively. The sensitivities of the four indexes with malignant pleural effusion were 60.0%, 65.7%, 42.9% and 57.1% respectively. The specificities were 90.9%, 84.8%,100% and 100% respectively. The Yonden indexes were 0.509,0.505,0.429 and 0.571 respectively. In the diagnosis of the malignant pleural effusion,combined the assay of the four indexes, the sensitivity and the accuracy of the diagnosis and the Yonden index would incerease significantly. Conclusion In the differential diagnosis of pleural effusion, the detection of hydrothorax CA153 is non-invasive, handy, practical and more valuable.