血清和胸水中CA125在结核性和癌性胸水中的表达及临床意义

The Expression and Clinical Significance of CA125 in Serum and Pleural Fluid in Malignant Pleural Effusion and Tuberculous Pleural Effusion

目的:探讨血清和胸水中CA125在结核性和癌性胸水中的表达及鉴别诊断意义。方法:抽选我院确诊的结核性胸水病人85例(结核组)和癌性胸水病人71例(癌症组),检测两组患者血清和胸水中CA125表达,并以胸水/血清中CA125比值>10(p-CA125/s-CA125>10)为临界值,观察其对癌性胸水的鉴别特异度、灵敏度及准确性。结果:癌症组胸水中CA125表达及p-CA125/s-CA125比值均显著高于结核组(P<0.05);但血清中两组CA125表达比较差异无显著性(P>0.05);两组胸水中,以35U/ml为临界值,两组患者阳性率92.9%(79/85)、100%(71/71)比较差异无显著性(X2=7.0718,P=0.0078)。癌症组中p-CA125/sCA125比值>10的比率(84.5%VS 17.6%)明显高于结核组(X2=66.6244,P=0.0000);并以其为诊断癌性胸水的临界值,鉴别诊断特异度、灵敏度及准确性分别为82.3%、84.5%、83.3%。结论:血清和胸水中CA125表达对于鉴别结核性或者是癌性胸水的临床意义不大,但是p-CA125/s-CA125比值对于鉴别结核性和癌性胸水具有一定临床价值。

Objective： To investigate expression and clinical significance of serum and pleural fluid CA125 in the malignant pleural effusion and tuberculous pleural effusion. Method： 85 cases of patients who were diagnosed with tuberculous pleural effusion （TB group） and 71 cases of patients with malignant pleural effusion （cancer group） in our hospital were selected, the CA125 expression in serum and pleural fluid of patients in two groups were detected, and pleural fluid/serum CA125 ratio〉10 （p-CA125/s-CA125〉10）were used as the critical value.The specificity, sensitivity and accuracy for the differential diagnosis of malignant pleural effusion were observed. Results： The CA125 levels and p-CA125/s-CA125 in pleural fluid in cancer group were significantly higher than those in the TB group （P〈0.05）; but the serum level of CA125 of the two groups were not significantly different （P〉 0.05）; 35U/ml were used as the critical value for pleural fluid in two groups, the positive rate of the two groups 92.9% （79/85）, 100% （71/71） presented no significant difference （X^2=-7.0718, P=0.0078）. The ratio ofp-CA125/s-CA125 （p-CA125/s-CA125〉10） of cancer group （84.5% VS 17.6%） was significantly higher than that of TB group （X^2=-66.6244, P=0.0000）; and its diagnosis of malignant pleural effusion threshold, identification diagnostic specificity, sensitivity and accuracy were 82.3%, 84.5%, 83.3% respectively. Conclusion： CA125 serum and pleural fluid levels present little clinical value for the differential diagnosis of tuberculosis and malignant pleural effusion , but p-CA125/s-CA125 has clinical value for the above differential diagnosis.