可溶性上皮型钙黏蛋白的检测在胸腔积液鉴别诊断中的意义

Value of soluble epithelial cadherin in differential diagnosis of pleural effusion

目的通过检测胸腔积液中可溶性上皮型钙黏蛋白(sE-cad)水平,探讨sE-cad对于胸腔积液鉴别诊断的意义。方法将胸腔积液患者分为恶性胸腔积液组、感染性胸腔积液组和漏出液组3组,其中感染性胸腔积液包括结核性胸腔积液和肺炎旁胸腔积液两个亚组,取第一次胸腔穿刺术所得的胸腔积液标本,应用ELISA法测定各种原因引起的胸腔积液中sE-cad的浓度。结果发现恶性胸腔积液中sE-cad浓度为(38.38±4.15)ng/mL,显著高于良性胸腔积液(14.17±0.80)ng/mL,与良性胸腔积液中各亚组比较均有统计学意义(P<0.001)。肺癌所致恶性胸腔积液(42.90±5.39)ng/mL和肺外恶性肿瘤胸膜转移所致恶性胸腔积液(26.07±3.55)ng/mL,两者间sE-cad浓度有显著差异(P<0.05)。胸腔积液中sE-cad浓度与癌胚抗原(CEA)呈显著相关(P<0.001)。根据ROC曲线,sE-cad取17.68 ng/mL为临界值,诊断恶性胸腔积液的敏感性为86.00%,特异性为85.00%,阳性预测值为88.00%,阴性预测值为85.00%,准确性86.67%,诊断效能中等。sE-cad和CEA联合诊断恶性胸腔积液具有最高的敏感性、特异性和准确性。结论测定胸腔积液中sE-cad浓度对鉴别良、恶性胸腔积液有一定价值,与CEA联合诊断恶性积液时具有最高的敏感性和特异性,值得在临床推广应用。

Objective To investigate the value of soluble epithelial cadherin （sE-cad）in the differential diagnosis of pleural effusion. Methods Patients were divided into malignant pleural effusion group, infective pleural effusion group and transudation group, sE-cad in pleural fluids obtained during the first thoracocentesis was measured by enzyme-linked immunosorbent assay （ELISA）. The concentration of sE-cad in all kinds of pleural effusions was compared. The cut-off value of sE-cad for the differential diagnosis of benign and malignant pleural effusion was determined by ROC curve. The diagnostic value of sE-cad was also compared with common tumor markers such as CEA, CA199, CA125 and NSE. Results The concentration of sE-cad was significant higher in the malignant pleural effusion than in the benign pleural effusion[ （38.38 ±4.15） ng/mL vs （14.17±0.80） ng/mL, P 〈 0. 001 ], There were also significant differences in the concentrations of sE-cad between malignant pleural effusion caused by lung cancer and metastatic lung cancer [ （42.90±5.39） ng/mL vs （26.07± 3.55） ng/mL, P 〈 0. 05 ]. sE-cad was positively correlated with CEA in pleural effusion （P 〈 0. 001）. According to the ROC curve, when the cut-off value of sE-cad was 17.68 ng/mL, the sensitivity of sE-cad was 86.00% , the specificity was 85.00% , the positive predictive value was 88.00% and the negative predictive value was 86.67%. The diagnostic value of the combination of sE-cad and CEA in malignant pleural effusion was the best, with the highest sensitivity, specificity and accuracy. Conclusion The detection of sE-cad in pleural effusion may be helpful in the differential diagnosis of benign and malignant pleural effusion. The diagnostic value of the combination of sE-cad and CEA is the best in sensitivity and specificity.