糖链抗原联合检测对肺癌合并胸腔积液的诊断价值

Diagnostic value of combined determination of CA72-4, CA242, CEA in lung cancer pleural effusion

目的联合检测胸腔积液中糖链抗原CA72—4、CA242、CEA的水平，探讨其对肺癌合并胸腔积液的诊断价值。方法采用酶联免疫吸附试验法对39例肺癌合并胸腔积液患者和35例良性疾病合并胸腔积液患者的胸腔积液进行CA72—4、CA242、CEA3项联合检测。根据ROC曲线选择肿瘤标志物的界值，以敏感性、特异性、阳性预测值、阴性预测值及准确率比较其在不同类型胸腔积液中的表达情况。结果肺癌患者胸腔积液中3项肿瘤标志物的平均水平明显高于良性疾病患者（P〈0．05）。CA72—4、CA242、CEA的ROC曲线下面积分别为0．703、0．727、0．804。CA72—4对肺癌性胸腔积液诊断的敏感性和特异性分别为64．1％、71．4％。CA242对肺癌性胸腔积液诊断的敏感性和特异性分别为59．0%、80．0％。各项肿瘤标志物联合检测时，CA72—4＋CEA和CA72—4＋CA242＋CEA对肺癌合并胸腔积液诊断的敏感性和特异性相同，分别为89．7％、94．3％，均高于其他联合。结论检测胸腔积液中糖链抗原CA72—4、CA242、CEA的水平对肺癌合并胸腔积液的诊断有一定价值；多项肿瘤标志物联合检测时，敏感性和特异性均较单项检测时高；最佳联合检测为CA72-4＋CEA。

Objective To evaluate the values of combined determination of CA72-4,CA242,CEA in the diagnosis of lung cancer pleural effusion. Methods 35 benign pleural effusion samples were enrolled. The Thirty-nine lung cancer pleural effusion samples and concentration of CA72-4, CA242, CEA in the pleural effusion of the 74 patients was determined with ELISA. The cut-off point for eath tumor marker was selected with receiver operating characteristic curves. The results were analyzed with sensitivity, specificity, positive prognostic value,negative prognostic value and accuracy. Results The values of CA72-4,CA242,CEA in the lung cancer pleural effusion were higher than those in the benign groups（ P 〈0.05）. The area under curve for CA72-4,CA242,CEA were 0. 703,0. 727,0. 804 respectivly. The sensitivity and specificity of CA72-4 were 64.1 % and 71.4% in lung cancer pteural effusion,68.4% and 71.4%. The sensitivity and specificity of CA242 were 59.0% and 80.0% in lung cancer pleural effusion. The sensitivity and specificity of CA72-4＋ CEA and CA72-4 ＋ CA242 ＋ CEA were 89.7% and 94.3%. Both were better than other combinations. Conclusions The determination of CA72-4,CA242,CEA in lung cancer pleural effusion are useful for the diagnosis of malignant pleural effusion associated with lung cancer. The combined determination of the three tumor markers can increase the sensitivity and the specificity in the diagnosis of lung cancer pleural effusion.