联合测量肿瘤标志物在鉴别良恶性胸腔积液中的诊断价值

Diagnostic value of combination measurement of tumor markers for differentiating malignant and pleural effusion

[目的]探讨联合测量胸水及血清中癌胚抗原(CEA),糖链抗原19-9(CA19-9)和糖链抗原125(CA125)在鉴别良恶性胸水中的诊断价值。[方法]用酶联免疫吸附测定法测量179例恶性胸腔积液与167例良性胸腔积液患者的血清和胸水中的CEA,CA19-9和CA125含量,分析其最佳诊断界值,独自及联合诊断的敏感性、特异性和准确率。[结果]以血清CEA≥3.90 ng/mL为界值,其诊断恶性胸腔积液的敏感性、特异性及准确率分别为59.78%、64.07%和62.85%。以胸水CEA≥2.55 ng/mL为界值,其诊断恶性胸腔积液的敏感性、特异性及准确率分别为65.36%、72.45%和68.79%。以胸水CA19-9≥5.75 ng/mL为界值,其诊断恶性胸腔积液的敏感性、特异性及准确率分别为51.95%、74.25%和62.72%。准确率最高的联合诊断方案为血清CEA+胸水CEA,准确率为70.34%。特异度最高的联合诊断为血清CEA+胸水CEA+胸水CA19-9,特异度为89.22%,与血清CEA+胸水CEA,血清CEA+胸水CA19-9及胸水CEA+胸水CA19-9比较,差异有显著性意义(P<0.05)。[结论]CEA和CA19-9在鉴别良恶性胸腔积液中具有重要的临床价值,而联合测量则可提高诊断准确率及特异度。

[Objective] To study the diagnostic value of determining carcinoembryonic antigen（CEA）,carbohydrate antigen 19-9（CA19-9） and carbohydrate 12-5（CA12-5） in the serum and pleural effusion in the differential diagnosis of benign and malignant pleural effusions.[Methods] The levels of tumor markers of CEA,CA19-9 and CA12-5 in serum and pleural effusion were measured in 179 patients with malignant pleural effusion and 167 patients with benign pleural effusion by ELISA method.The best diagnostic cut-off and the sensitivity,specificity and accuracy of them were analyzed.[Results] If the cut-off of serum CEA was ≥ 3.90 ng/mL,the sensitivity,specificity and accuracy of diagnosing malignant pleural effusion were 59.78%,64.07% and 62.85% respectively.If the cut-off of pleural effusion CEA was ≥ 2.25 ng/mL,the sensitivity,specificity and accuracy of diagnosing malignant pleural effusion were 65.36%,72.45% and