肺泡灌洗液中肿瘤相关物质群对肺周围型孤立结节鉴别诊断的价值

Clinical value of tumor specific growth factors in bronchoalveolar lavage fluid on differential diagnosis of periphery solitary pulmonary nodules.

目的探讨血清和支气管肺泡灌洗液（BALF）中肿瘤相关物质群（TSGF）对肺周围型孤立结节良恶性鉴别诊断的价值。方法对211例周围型肺部孤立结节患者行血清和健、患双侧支气管肺泡灌洗液TSGF、癌胚抗原（CEA）检测并与196例非肿瘤性疾病患者进行对照。结果恶性结节患者血清和健、患双侧支气管肺泡灌洗液CEA[分别为血清（28．73±15．61）、健侧（63．31±21．28）、患侧（85．54±26．19）μg/L]、TSGF[分别为血清（88．73±13．51）、健侧（110．734±18．64）、患侧（162．80±58．89）μg／L]均高于良性患者[CEA血清为（7．21±2．43）、健侧（12．36±6．93）、患侧（14．65±8．07）μg/L；TSGF血清为（56．31±2．43）、健侧（79．25±36．86）、患侧（86．29±37．07）μg／L]及对照组[CEA血清为（4．68±1．25）、患侧为（11．06±8．03）μg／L]，恶性结节组患侧支气管肺泡灌洗液TSGF、CEA检测亦高于健侧，患侧BALF中TSGF测定对恶性诊断的敏感性、特异性和正确性分别为86．6％、100．0％和98．6％，高于CEA的70．2％、78．9％和76．5％及血清TSGF的73．1％、88．9％和85．7％。结论支气管肺泡灌洗液及血清TSGF测定对肺周围型孤立结节的良、恶性具有重要的鉴别诊断价值，尤其健、患双侧BALF中TSGF检测对肿瘤有定位诊断作用。

Objective To explore clinical value of tumor specific growth factors （TSGF） in serum and bronchoalveolar lavage fluid （BALF） on differential diagnosis of benign and malignant periphery solitary pulmonary nodules （PSPN）. Methods Serum and BALF from both normal and afflicted side were collected from 211 patients with PSPN（case group） and from 196 patients without any type of tumor （control group）. TSGF and carcinoembryonic antigen （CEA） in serum and BALF were measured in both groups. Results In the malignant PSPN patients, CEA in serum, normal and afflicted side were 28.73 （ SD： 15.61 ） μg/L,63.31 （ SD ：21.28） μg/L and 85.54 （ SD ： 26.19 ）μg/L, respectively, which was significantly higher than that of the benign PSPN patients （7.21 （SD ：2.43 ） μg/L, 12.36（SD：6.93） μg/L and 14.65（SD：8.07） μg/L,respectively） ,as well as that of the control group （4.68 （ SD： 1.25）μg/L and 11.06 （ SD： 8.03） μg/L in serum and BALF, respectively （P 〈 0.05 ）. TSGF in the serum and BALF from the normal and afflicted side of malignant PSPN patients was 88.73 （ SD ： 13.51 ） μg/L, 110.73 （ SD ： 18.64） μg/L and 162.80 （ SD ： 58.89 ） μg/L, respectively, which were significantly higher than that of the benign PSPN patients （56.31 （ SD ：2.43 ） μg/L, 79.25 [ SD ： 36.86 ] and 86.29 （ SD ： 37.07 ） μg/L, respectively） （ P 〈 0. 05）. Furthermore, in the malignant PSPN patients, TSGF and CEA in the afflicted side were significantly higher than that of the normal side. Sensitivity, specifieity and accuracy of TSGF in BALF from the afflicted side for malignant diagnosis were 86.6% ,100.0% and 98.6% ,respectively,which was higher than that of CEA （70.2% ,78. 9% and 76.5% respectively） and that of serum TSGF （73.1% ,88.9% and 85.7% respectively）. Conclusions TSGF in bronchoalveolar lavage fluid and serum has a significant role in differential diagnosis of benign and malignant periphery solitary pulmonary nodules. Furthermore, measurement of TSGF in bilateral BALF is helpful in diagnosis of tumor location.