联合检测肿瘤标志物对恶性胸腔积液的诊断价值

The diagnostic value of combined detection of tumor markers for malignant pleural effusions

目的探讨联合检测血清及胸腔积液中肿瘤标志物的浓度对鉴别良恶性胸腔积液的意义。方法选取我院胸腔积液患者376例，分别检测其胸腔积液及血清中癌胚抗原（CEA）、神经特异性烯醇化酶（NSE）、癌抗原125（CAl25）、鳞状细胞癌抗原（SCC）浓度，并结合组织学或细胞学证据，运用统计学方法分析相关数据。结果恶性组298例，良性组78例，两组胸腔积液中CEA、NSE、SCC、CA125浓度分别为（279．9±170．0）、（12．6±6．2）pg／L，（112．3±86．8）、（14．7±7．3）μg／L，（10．6±5．4）、（1．2±0．6）wg／L，（409．2±206．7）、（44．0±20．5）U／ml，差异均有统计学意义（t值分别为6．29、5．13、2．34、7．46，P均〈0．01），恶性组与良性组血清中上述4种肿瘤标志物浓度分别为（86．7±42．0）、（6．24-3．1）μg/L，（31．6±18．2）、（11．2±5．0）μg/L，（3．5±2．2）、（1．8±0．8）μg/L，（134．0±72．6）、（19．8±9．6）U／ml，组间比较差异均有统计学意义（t值分别为3．14、4．61、1．70、4．04，P均〈0．01）。联合检测胸腔积液及血清各肿瘤标志物（按平行试验）敏感性为100％，按序列试验特异性为100％。结论检测胸腔积液中CEA、NSE、CA125、SCC的浓度更有利于鉴别胸腔积液的良恶性，联合检测胸腔积液及血清中肿瘤标志物浓度能提高诊断的敏感性。

Objective To investigate the significance of combined detection of tumor markers in serum and pleural fluid on differential diagnosis of benign and malignant pleural effusion. Methods Three hundred and seventy six cases of pleural effusion were selected. The levels of carcinoembryonic antigen （ CEA）, neuronspecific enolase（ NSE）, cancer antigen 125 （ CA125 ）, squamous cell carcinoma antigen （ SCC ） in serum and pleural fluid were examined and they were analyzed combined with histological or cytological evidence using statistical methods. Results There were 298 cases in malignant group and 98 cases in benign group. The levels of the four tumor markers in malignant group were significantly higher than in benign group both in pleural fluid （CEA：[279. 9 ±170.0]μg/L v. s. [12.6 ±6.2] μg/L,t =6.29,P 〈0.01;NSE： [ 112.3±86. 8] μg/L v.s. [14.7 ±7. 3] μg/L,t =5.13,P 〈0.01;SCC： [ 10. 6 ±5.4] μg/L v. s. [1.2 ±0.6] μg/L,t =2. 34,P 〈0.01; CA125 ： [ 409. 2 ± 206. 7 ] U/ml v. s. [ 44.0 ± 20. 5 ] U/ml, t = 7.46, P 〈 0. 01 ） and in serum （ CEA ： [ 86. 7 ±42. 0] μg/L v. s. [6.2±3.1] μg/L,t =3.14,P 〈0.01;NSE：[31.6 ± 18. 2]tμg/L v. s. [11.2 ±5.0]μg/L,t = 4. 61,P〈0. 01;SCC：[3.5 ±2. 2]μg/L v. s. [1.8 ±0.8]μg/L,t=l.70,P〈0. 01;CA125：[134.0±72.6]U/ ml v. s. [ 19. 8 ± 9. 6] U/ml, t = 4.04, P 〈 0. 01 ）. Moreover, the levels of tumor markers in pleural fluid were higher than in serum. The sensitivity were 100% by combined detection of pleural fluid and serum tumor markers in parallel and the specificity were 100% in sequence. Conclusion The levels of CEA, NSE, CA125, SCC in pleural effusion were more sensitive than which in serum. Combined detection of tumor markers in pleural fluid and serum could improve the sensitivity of diagnosis for benign and malignant pleural effusion.