胸水ProGRP及CEA联合检测在肺癌并发恶性胸腔积液诊断中的价值

Significance of Combinatory Detection of Hydrothorax ProgastrinReleasing Peptide and Carcino-embryonic Antigen in Diagnosisof Lung Cancer Complicated with Malignant Pleural Effusion

目的探讨胸水胃泌素前体释放肽片断31-98(ProGRP)及癌胚抗原(CEA)单项及联合检测对肺癌所致恶性胸腔积液的诊断价值。方法采用酶联免疫吸附实验对33例小细胞肺癌(SCLC)所致的恶性胸腔积液患者(SCLC组)、36例非小细胞肺癌(NSCLC)所致的恶性胸腔积液患者(非SCLC组)及32例良性胸腔积液患者(良性胸腔积液组)进行胸水ProGRP、CEA检测,比较胸水ProGRP、CEA单项及联合检测对恶性胸腔积液的诊断价值。结果在SCLC组、NSCLC组和良性胸腔积液组胸水ProGRP测定的阳性率分别为90.91%,2.78%和3.00%,在SCLC组、NSCLC组和良性胸腔积液组胸水CEA测定的阳性率分别为45.45%,83.33%和12.00%。胸水ProGRP单项检测、CEA单项检测、ProGRP+CEA联合检测(按序列实验)和ProGRP+CEA联合检测(按平行实验)诊断SCLC所致的恶性胸腔积液的Youden指数分别为0.877 8,0.048 3,0.483 9及0.751 9;诊断NSCLC所致的恶性胸腔积液的Youden指数分别为-0.003 5,0.708 3,0.135 4及0.673 6;诊断肺癌所致的恶性胸腔积液的Youden指数分别为0.251 2、0.402 2,0.307 0及0.711 1。结论ProGRP和CEA分别为染煤矿区职工SCLC和NSCLC所致的恶性胸腔积液较有价值的胸水肿瘤标志物;胸水ProGRP+CEA联合检测(按平行试验)对肺癌所致的恶性胸腔积液有较高的诊断价值。

Objective To study the clinical significance of combinatory detection and detection alone of the hydrothorax progastrin releasing peptide（ProORP）and carcino-embryonic antigen（CEA）in diagnosis of malignant pleural effusion induced by lung cancer. Methods By the ELISA（enzyme linked immunosorbnent assay）, the levels of hydrothorax ProGRP and CEA were detected in 33 cases of malignant pleural effusion induced by SCLC （small cell lung cancer）, 36 malignant pleural effusion induced by NSCLC （non-small-cell lung cancer）, and 32 benign hydrothorax（the benign group）, respectively. The significance of combinatory detection and detection alone of the hydrothorax ProGRP and CEA in the diagnosis of the malignant pleural effusion was compared. Results The positive rates of hydrothorax ProGRP in the SCLC group, the NSCLC group and the benign group were 90. 91%, 2.78% and 3.00 % respectively; the positive rates of hydrothorax CEA in these three groups were 45.45%, 83.33%, and 12.00 % respectively. The Youden indexes of the hydrothorax ProGRP alone, the CEA alone, the ProGRP＋CEA combinatory（according to sequence tests）and the ProGRP＋CEA combinatory（in parallel tests）in diagnosis of the malignant pleural effusion induced by the SCLC were 0. 877 8, 0. 048 3, 0. 483 9 and 0. 751 9 respectively. The Youden indexes in diagnosis of the malignant pleural effusion induced by the NSCLC were -0.003 5, 0.7083, 0.135 4 and 0.6736 respectively. The Youden indexes in diagnosis of the malignant pleural effusion induced by lung cancer were 0. 251 2, 0. 402 2, 0. 307 0 and 0. 711 1 respectively. Conclusions The hydrothorax ProGRP and CEA are preferable biomarkers of cancer in diagnosis of the malignant pleural effusion induced by the SCLC and NSCLC. Combinatory detection of hydrothorax ProGRP＋CEA in parallel tests is highly significant in the diagnosis of the malignant pleural effusion induced by lung cancer.