密度梯度离心法检测脱落肿瘤细胞对恶性胸腔积液的诊断价值

Diagnostic Value of the Exfoliative Tumor Cells Isolated by Density Gradient Centrifugation from the Malignant Pleural Effusions

胸腔积液是临床常见征象，其良恶性质的鉴别是临床上尚未解决的难题之一．本试验对３６例恶性胸腔积液，３０例结核性胸腔积液分别用密度梯度离心法、常规离心涂片法检测脱落肿瘤细胞，并对其中２２例恶性胸液患者行胸膜活组织检查．结果密度梯度离心法之脱落肿瘤细胞检出率为９１．７％，常规离心涂片法检出率为４４．４％，针刺胸膜活检法检出率为４０．９％，常规离心涂片联合针刺胸膜活检的检出率为５４．５％；密度梯度离心法对脱落肿瘤细胞的检出率明显高于常规离心涂片法（ｐ＜０．００５）或／和胸膜活检法（ｐ＜０．００５），且无假阳性．表明用密度梯度离心法检测胸液脱落肿瘤细胞是一阳性率高且简便实用的特异性方法。

The pleural effusion is a common complication to some patients. The differentiation between malignant pleural effusions and benign pleural effusions has been a difficult problem in clinical practice. This paper recorded the results of an examination of the exfoliative tumor cells in 36 cases with malignant pleural effusions, 22 cases of which underwent pleural needle biopsy, by using density gradient centrifugation and routine centrifugation smear cytologic examination. Comparisons were also made between these results and those of 30 cases of benign pleural effusions. It was demonstrated that the positive rates of density gradient centrifugation, routine centrifugation smear cytologic examination and pleural needle biopsy for diagnosing malignant pleural effusions were 91 7%, 44.4% and 40.9% respectively, and the positive rate of routine centrifugation smear cytologic examination combined with pleural needle biopsy for diagnosing malignant pleural effusions was 54.5%. The positive rate of the exfoliative tumor cells by density gradient centrifugatin was much higher than that of routine centrifugation smear cytologic examination ( p< 0.005) or/and pleural needle biopsy ( p <0.005) with no false positive. This shows that the exfoliative tumor cells isolated by density gradient centrifugation from the malignant pleural effusions are quite specific for the diagnosis of malignant tumors with higher sensitivity and practicability in clinico pathological practice.