血管内皮生长因子与细胞角蛋白19片段对胸腔积液的鉴别诊断

The Significance of Levels of CYFRA21-1 and VEGF in Pleural Effusion in Differentiating Tuberculosis and Malignant Pleural Effusions

目的:探讨血管内皮生长因子(VEGF)与细胞角蛋白19片段(CYFRA21-1)对鉴别结核性和恶性胸腔积液的临床意义,提高恶性胸腔积液诊断阳性率。方法:采用双抗体夹心免疫酶标法检测42例结核性胸腔积液和34例恶性胸腔积液中CYFRA21-1、VEGF水平,并比较两项指标的敏感性、特异性及精确度。结果:结核性胸腔积液中VEGF水平为(318.82±173.14)pg/ml,CYFRA21-1水平为(12.72±11.06)ng/ml,低于恶性胸腔积液的(814.48±284.04)pg/ml和(38.87±19.67)ng/ml,差异具有非常显著性意义(P<0.01)。VEGF的敏感性和特异性分别为79.41%和95.24%,CYFRA21-1的敏感性和特异性分别为67.65%和92.86%,联合检测单项阳性敏感性85.29%,双项阳性的特异性为100.00%。结论:恶性胸腔积液的VEGF与CYFRA21-1水平显著高于结核性胸腔积液,联合检测VEGF与CYFRA21-1有助于胸腔积液良、恶性的鉴别诊断。

Objective ：To investigate the significance of VEGF and CYFRA21-1 in differentiating benign and malignant pleural diseases to increase the negative rate of malignant pleural effusions. Methods： Levels of VEGF and CYFRA21-1 were detected using ELISA method in pleural effusion of 42 cases of tuberculosis pleural effusion and 34 cases malignant pleural effusion to compare the sensitivity and specialty of the two indexes. Results ： VEG F levels in the tuberculosis pleural effusion were （ 318.82 ± 173.14 ） pg/ml, significantly lower than those of malignant patients with pleural effusion. CYFRA21-1 levels in the tuberculosis pleural effusion were （12.72 ± 11.06）ng/ml, significantly lower than those of malignant patients with pleural effusion （814.48 ±284. 04 ）pg/ml and （38.87 ± 19. 67 ）ng/ml ,the difference of which was statistically significant （P 〈 0.01 ）. The sensitivity and specialty ,of VEGF were 79.41% and 95.24% respectively,while the sensitivity and specialty of CYFRA21-1 were 67.65% and 92. 86%. The sensitivity of single positive test was 85.29% , while the dual positive test was 100.00%. Conclusion ： The levei of VEGF and CYFRA21-1 in malignant pleural effusion is obviously much higher than that of the tuberculosis pleural effusion. VEGF combined with CYFRA21-1 measurement might be an useful index in differentiating diagnosis of benign and malignant pleural effusions.