端粒酶和癌胚抗原在胸腔积液性质鉴别诊断中的价值

Clinical significance of quantitive measurement of telomerase and CEA in malignant pleural effusions

目的探讨端粒酶和癌胚抗原(CEA)在胸腔积液性质鉴别诊断中的价值,并研究化疗对端粒酶表达的影响,为其临床应用提供实验依据。方法选取60例胸腔积液患者,其中恶性胸腔积液30例,良性胸腔积液30例。抽取胸腔积液后采用PCR荧光定量及化学发光方法进行端粒酶、CEA检测。恶性胸腔积液患者化疗4周后复查端粒酶表达。结果恶性胸腔积液中的端粒酶、CEA水平明显高于良性胸腔积液,差异有统计学意义(均P<0.05)。CEA在恶性胸腔积液中诊断阳性界值为1.15ng/ml,敏感性为56.7%,特异性为53.3%。端粒酶在恶性胸腔积液中诊断阳性界值为2.0×10-3amoles/L,敏感性为66.7%,特异性为60.0%。端粒酶+CEA联合检测的敏感性为76.7%,特异性为80.0%。恶性胸腔积液患者化疗4周后胸腔积液中端粒酶表达由(3.02±2.03)×10-3amol/L降为(1.81±0.84)×10-3amol/L。结论端粒酶、CEA检测对良恶性胸腔积液的鉴别诊断有一定的临床意义,两者联合检测可提高诊断的敏感性和特异性。化疗可使端粒酶表达明显下降。

Objective To assessment the value of telomerase and CEA in differential diagnosis between malignant and benign pleural effusion. Methods The expression of telomerase and CEA were measured by RT-PCR and chemical luminescence methods in 30 samples of malignant pleural effusion and 30 benign ones. The expression of telomerase in malignant pleural effusion was measured again after four weeks of chemotherapy. Results The level of telomerase and CEA in malignant pleural effusion was significantly higher than that in benign one. The sensitivity and specificity of CEA was 56.7% and 53.3% respectively using 1.15ng/ml as the cutoff value for malignancy. The sensitivity and specificity of telomerase was 66.7% and 60.0% respectively using 2.0 × 10^-3 amal/L as cutoff value for malignancy. The sensitivity and specificity of telomerase ＋ CEA was 76.7% and 80.0% respectively. After four weeks of chemotherapy, the expression of telomerase in malignant pleural effusion declined from （3.02 ± 2.03） × 10^-3 amol/L to （1.81 ± 0.84） × 10^-3 amol/L. Conclusion The combined testing of telomerase with CEA may improve the sensitivity and specificity for diagnosis of malignant plural effusion. In addition, chemotherapy can decline the expression of telomerase in malignant pleural effusion.