蛋白C和蛋白S在良恶性胸腔积液鉴别诊断中的意义

Differential diagnostic value of the activity of protein C and protein S in malignant and benign pleural effusions

目的通过测定良恶性胸腔积液病人血和胸水中蛋白C(PC)和蛋白S(PS)的变化,以期为胸腔积液的鉴别诊断提供另1个辅助性诊断方法。方法良性组26例、恶性组22例及正常对照者26例,用血液凝固法分别测定血浆和胸水中PC、PS活性。结果(1)血浆中,对照组、恶性组、良性组PC活性分别为(115·24±45·19)%、(90·89±30·23)%、(58·93±26·64)%,3组比较均有显著差异(P<0·05);而PS活性均无显著差异(P>0·05)。(2)胸水中,PC活性良性组高于恶性组(P=0·03),而PS活性组间无统计学差异(P=0·31)。(3)血浆/胸水PC比值,恶性组明显高于对照组(P<0·01),而PS的比值组间无显著性差异(P=0·08)。(4)单用血浆/胸水PC比值诊断恶性胸腔积液的敏感性为95·00%,准确率为72·54%,阳性、阴性预测值分别为65·53%和90·95%,特异性为50·00%;血浆PC与血浆/胸水PC比值、胸水PC与血浆/胸水比值联合应用时的敏感性也达到90·50%和90·50%,特异性分别为57·83%和67·89%,准确率分别为70·51%和57·55%,阴性预测值分别为85·74%和81·83%。结论恶性组血浆PC活性明显高于良性组,而胸水PC活性低于良性组,因此PC活性、血浆/胸水PC比值可用于良恶性胸腔积液的鉴别诊断。

Objective To study diagnostic value of protein C （ PC ） and protein S（PS） in blood and pleural effusions in differentiating malignant from benign pleural effusions. Methods PC and PS of 48 samples of plcoral effusions and blood were examined in patients by blood coagulation test. Meanwhile 26 samples of blood of healthy controls were examined. Statistical analysis was performed with SPSS11. 0. Results （1）TheactivityofPCandPSinblcodare90.89±30.23and88.12±50.62（malignant ） ,58.93± 26.64 and 98.00 ± 26.17 （ benign）, 115.24 ± 45.19 and 85.19 ± 34.67 （control） ,respectively. Though activity of PS within the three groups is of no difference（ P 〉 0. 05 ）, PC is significantly different （ P 〈 0. 05 ）. （ 2 ） The activity of PC and PS in malignant pleurat effusions are（27.76 ± 11.80） % and （ 114.57 ± 74.00） % ,and those in benign pleural effusions are （ 40.54± 25.60） % and （ 94.80 ± 43.18 ） %. The change of PC between two groups is significant （ P = 0. 03 ）. But the activity of PS shows no different within the groups （ P = 0. 31 ）. （3） The PC ratio of serum to pleural effusions is dramatically increased in malingnant group（ P 〈 0. 05 ）, while the result of PS is not（ P 〉 0. 05 ）. （4）The diagnostic sensitivity of single PC ratio in malignant pleural effusions is 95.00% ,the specificity is 50. 00% ,the accuracy is 72.54% ,the positive and negative predictive value are 65.53% and 90.95% respectively. When combined the ratio of serum to pleural effusion with PC activity in blood or pleural effusions,diagnostic sensitivity is increased to 90.50% and 90. 50%, specificity 57.83% and 67.89%, accuracy 70.51% and 57. 55%, negative predictive value,85.74% and 81.83% ,respectively. Conclusions The results indicate that the blood PC level of malignant group is obviously higher than that of benign group, but lower in pleural effusions. That means PC activity and/or the ratio of serum of topleural fluid may be used to differentiate benign from malignant effusions ,though further study maybe needed for the value of the PS.