DNA倍体联合肿瘤标志物检测在胸腔积液诊断中的应用

Diagnostic application of the DNA ploidy analysis combined tumor markers in the pleural effusion

目的探讨DNA倍体分析联合肿瘤标志物在良、恶性胸腔积液诊断中的价值。方法将108例胸腔积液分为恶性组(68例)和良性组(40例)。除常规细胞学检查外,以流式细胞术(flow cytometry,FCM)检测患者胸腔积液中的DNA倍体,采用化学发光法测定胸腔积液中CEA、CA199、NSE、CYFRA211、SCC、CA125等肿瘤标志物含量。比较DNA倍体联合肿瘤标志物诊断与细胞学诊断的优劣。结果 DNA倍体诊断恶性胸腔积液的敏感性、特异性分别为70.6%、95.0%,Youden's指数为0.656,敏感度稍高于细胞学诊断的65.1%,差异无统计学意义(P>0.05)。除NSE外,其他5种肿瘤标志物在恶性胸腔积液中浓度均高于良性,差异有统计学意义(P<0.05)。CYFRA211、CEA、CA199、CA125、SCC、NSE的AUC分别为:0.893,0.828,0.759,0.691,0.524及0.490;COV分别为:149.2ng/mL,53.6ng/mL,78.2IU/mL,1559.0IU/mL,48.72ng/mL及78.3ng/mL;敏感性分别为:44.1%,44.1%,35.3%,29.4%,13.2%,5.9%,特异性均为100%。4种肿瘤标志物联合检测+DNA倍体检测的敏感性为88.2%(60/68),特异性95%,显著高于细胞学诊断。结论 DNA倍体联合CEA、CA199、CYFRA211和CA125检测诊断恶性胸腔积液有较高敏感性,具有定量、快速、价廉、易标准化的特点,且操作简单。

Objective To investigate the diagnostic value of DNA ploidy analysis combined the tumor markers in the diagnosis of benign and malignant pleural effusions. Methods 108 patients with malignant pleural effusions were divided into Malignant group （68 cases） and benign group （40 cases）. They were all detected by DNA ploidy analysis by flow cytometry and examined for CEA, CA199, NSE, CYFRA211, SCC and CA125 level by chemiluminescence at the same time. Meanwhile, we compared the combination with cytological examination in the diagnosis of benign and malignant pleural effusions. Results The sensitivity of DNA ploidy detection with flow cytometry was 70.6%, the specificity was 95.0%, the Youden＇s index was 0.656, the sen- sitivity of DNA ploidy detection was higher than the cytologic diagnosis, there was no significant difference in the sensitivity of the two groups（P 〉 0.05）. In addition to the NSE, the other five tumor markers levels in malignant pleural effusion were significant higher than that in benign （P 〈 0.05）. The AUC levels of CYFRA211,CEA, CA199, CA125, SCC and NSE were： 0. 893 ,0. 828,0. 759,0. 691,0. 524 and 0. 490 respectively; COV were ： 149.2 ng/mL and 53.6 ng/mL and 78.2 IU/mL, 1 559.0 IU/mL, 48.72 ng/mL and 78.3ng/mL; sen- sitivity ： 44.1% , 44.1% , 35.3% , 29.4% , 13.2% , 5.9% , and the specificity was 100%. The sensitivity of these four kinds markers combined DNA ploidy detection was 88.2% 60/68）, and the specificity is 95% , that is significantly higher than the cytological diagnosis. Conclusions DNA ploidy analysis combined CEA, CA199, CYFRA211, and CA125 have a higher sensitivity, therefore, it is good value detection for malignant pleura1 effusion and it is suitable for clinical application.