胸腔积液细胞形态学、生物化学、肿瘤标志物检测对诊断恶性肿瘤的临床意义

The Clinical Significance of Analysis of Cell Morphology,Biochemistry and Tumour Markers in Pleural Effusion for Diagnosing Malignant Tumours

目的:对胸腔积液进行细胞形态学、生物化学、肿瘤标志物的检测,探讨其结果在诊断恶性肿瘤方面的临床意义。方法:胸腔积液细胞形态学检测采用离心推片法及瑞氏-姬姆萨复合染色鉴定细胞性质;LDH、TP、Cl、ALB、TC、Crp生物化学指标在奥林巴斯2700全自动生化分析仪上检测;CEA、CYFRA21-1、NSE肿瘤标志物在Elecsys 2010上检测,FDP检测采用酶联免疫胶乳凝集法。结果:在选择的60例胸腔积液标本中,有30例胸腔积液为恶性肿瘤,查到癌细胞24例,检出率80%,与病理学、影像学恶性肿瘤诊断符合率为95%,但是未查到癌细胞并不一定能排除恶性肿瘤,本组资料的癌细胞阳性率为80%(24/30)。LDH阳性率为67%(20/30),FDP阳性率为47%(14/30),CEA阳性率为50%(15/30),CYFRA21-1阳性率为77%(23/30)。TP、Cl、ALB、TC、Crp、NSE的检测在鉴别肿瘤方面无显著性差异(P>0.05)。结论:查到癌细胞和CEA、CYFRA21-1、LDH、FDP的联合检测在鉴别恶性肿瘤方面有显著性差异(P<0.01),为恶性肿瘤的鉴别诊断提供了可靠依据。因此在临床诊断中综合分析这些指标可作为恶性肿瘤诊断的依据,值得大力推广。

Objective： To study the clinical significance of cell morphology, biochemistry and tumour markers in pleural effusion for diagnosing malignant tumours.Methods：The cell morphology was detected by use of the smear of centrifuged pleural effusion and Wright-Giemsa compound staining to identify the cell nature. LDH, TP, C1, ALB, TC and Crp were detected with Olinplus 2700. CEA,CYFRA21-1 and NSE were determined with Elecsys 2010 and FDP with enzyme-linked immuno latex agglutination. Results： Among the 60 patients with pleural effusion the malignant tumours were found in 30 cases, and in 24 cases of the 30 patients the cancer cells had been detected, the detection rate was 80%,compared with pathologic and imaging diagnosis the coincidence rate was 95%. Even the cancer cells are not found, it is by no means exclusion of the malignant tumours. The positive rate of cancer cell was 80% in this study. The positive rate was 67% in LDH,47% in FDP,50% in CEA and 77% in CYFRA21-1. There were no difference in detection of TP,Cl, ALB,TC,Crp and NSE for distinguishing malignant tumours （P〉0. 05）. Conclusion：There are remarkable differences between finding out cancer cell and distinguishing malignant tumours through joint testing CEA, CYFRA21-1, LDH and FDP（P〈0. 01）. So combination analysis of these indexes can provide reliable basis for clinical diagnosis of malignant tumours.