癌性与结核性胸腔积液的鉴别诊断探讨

Differenfial Diagnosis of Cancerous and Tuberculous Pleural Effusion

我们观察30例癌性胸腔积液(其中27例为肺癌引起)和38例结核性胸膜炎患者的胸水及血清3项同位素放射免疫测定:癌胚抗原(CEA)、β_2微球蛋白(β_2M)及铁蛋白(Ferritin),并对胸水进行细胞学和染色体分析。发现CEA对鉴别诊断价值最大(P<0.001)。胸水CEA>16ng/ml及胸水/血清CEA比值≥1可诊断为癌性积液。胸水β_2-M>4.6μg/ml,结核性为60.5％,癌性仅18.1％,两组有显著差异(P<0.05)。两组铁蛋白值均升高无鉴别诊断意义(P>0.5)。对胸水染色体进行分析发现癌性胸水61.9％有超二倍体,而结核性胸水均为二倍体和亚二倍体,其敏感性大于细胞学诊断,有助于提高诊断率。

CEA, β_2-M globulin and ferritin were measured by radioimmunoassay in 68 Pa- tients with pleural effusion (38 tuberculous, 30 cancerous). Cytologic study and chro- mosome examination of effusion revealed CEA level was the most sensitive parame- ter. Cancerous nature of the effusion could be established if the CEA level was high- er than 16ng/ml, or if the ratio of CEA in effusiou/CEA in serum≥1. The β_2-M effusion content was more than 4.6μg/ml in 60.5% cases of tuberculous effusion while it was only 18.1% cases of malignant effusion. The difference was statistical signi- ficance(P<0.05).Ferritin value was elevated in either kind of effusion and showed no diagnostic significance. Hyperdiploid of chromosome was found in 61.9% cases of cancerous effusion, and in cases of tuberculous effusion diploid or hypodiploid was the rule.It seems to the author that chromosome changes were more useful than cyt- ologic changes in differential diagnosis of tuberculous from malignant pleural effu- sion.