胸腔积液及肺泡灌洗液中X链锁凋亡抑制蛋白及生存素检测对肺癌的早期诊断价值

Levels of X-linked inhibitor of apoptosis protein and survivin in pleural effusion and bronchoalveolar lavage fluid in early diagnosis of lung cancer

目的探讨胸腔积液及肺泡灌洗液中X链锁凋亡抑制蛋白(X-1inked inhibitor of apoptosis protein,XIAP)及生存素(survivin)水平对肺癌早期诊断的临床价值。方法 60例经病理确诊的肺癌伴胸腔积液患者的胸腔积液及肺泡灌洗液作为肺癌组,60例结核性渗出性胸膜炎患者的胸水及肺泡灌洗液为对照组,以酶联免疫吸附法测定2组中XIAP、生存素含量,并对其进行统计学分析。结果恶性胸腔积液中XIAP水平高于结核性胸腔积液患者,(84.83±27.40)ng/L vs(47.23±21.58)ng/L(P<0.05),恶性胸水患者肺泡灌洗液中XIAP水平明显高于结核性胸腔积液患者肺泡灌洗液患者,(85.02±41.22)ng/L vs(43.10±28.61)ng/L(P<0.05);恶性胸腔积液中survivin浓度高于结核性胸腔积液患者,(85.54±29.18)ng/L vs(43.15±21.98)ng/L(P<0.05);恶性组肺泡灌洗液中survivin显著高于结核性胸腔积液患者的肺泡灌洗液中survivin,(95.27±34.54)ng/L vs(48.99±22.17)ng/L(P<0.05);单个检查XIAP、生存素在胸腔积液中的敏感度85.0%、90.0%,在肺泡灌洗液中的敏感度75.0%、95.0%,XIAP+生存素联合检查在胸腔积液敏感度及肺泡灌洗液中均为95.0%,但特异度降低。结论胸腔积液中XIAP及生存素的测定有利于良恶性胸腔积液的鉴别诊断,同时由于肺泡灌洗中XIAP及生存素的含量高于胸腔积液,且敏感度较高,对于肺癌的早期诊断具有重要的意义。

Objective To investigate the diagnostic value of X-linked inhibitor of apoptosis protein（XIAP） and survivin in pleural effusion and bronchoalveolar lavage fluid （BLAF）. Methods Pleural effusion and bronchoalveolar lavage fluid specimens were collected from 60 patients with lung cancer and 60 patients with tuberculous pleurisy （control）, XIAP and survivin in two groups were determined by ELISA, the results were analyzed with statistical methods. Results XIAP levels in malignant pleural effusion were higher than in tuberculosis pleural effusion, （84.83± 27.40） ng/L vs （47.23±21.58） ng/L（ P 〈0.05）;XIAP levels in BALF were higher in the patients with malignant pleural effusion than in the patients with tuberculosis pleural effusion, （85.02±41.22） ng/L vs （43.10±28.61） ng/L （P 〈0.05） ;survivin levels in malignant pleural effusion were higher than in tuberculosis pleural effusion, （85.54 ± 29.18） ng/L vs （43.15±21.98） ng/L（ P 〈0.05） ;XIAP levels in BALF were higher in the patients with malignant pleural effusion than in the patients with tuberculosis pleural effusion, （95.27±34.54） ng/L vs （48.99±22.17） ng/L （ P 〈0.05） ;The levels of XIAP and survivin in lung cancer were significantly higher than those of benign lung diseases （ P 〈0.05）. The sensitivity of single examined XIAP, survivin measurement in pteural effusion were 85.0%, 90.0 %, and in BAIF were 75.0%,95.0%, the sensitivity of combined XIAP, survivin measurement in pleural effusion and BAIF were 95.0%, but the specifity was low. Conclusion Detection of XIAP, survivin in pleural effusion are useful in differential diagnosis of benign and malignant effusion. The content of XIAP, survivin in BALF are higher than those in pleural effusion,and the sensitivity is higher, so combining measurement in BALF can improve the early diagnosis of lung cancer.