联合检测ADA、CA125和CEA对结核性与恶性胸腔积液的诊断价值

Clinical application of combined detection of ADA, CA125 and CEA in tuberculous pleural effusion and malignant pleural effusion

目的 探讨联合检测胸腔积液中腺苷脱氨酶（ADA）、糖类抗原125（CA125）和癌胚抗原（CEA）对结核性与恶性积液的鉴别诊断价值.方法 采用酶连续监测法和化学发光免疫分析法检测82例结核性积液及56例恶性胸腔积液中ADA、CA125和CEA的水平,并对检测结果进行综合分析.结果 结核性胸腔积液中平均ADA含量明显高于恶性胸腔积液,而CEA和CA125平均水平明显低于恶性胸腔积液（P＜O.05）.以ADA＞40U/L为临界值,对结核性积液的敏感性、特异性和准确性分别为82.8％,80.4％和81.7％.以CA125＞35U/ml和CEA＞5μg/L为临界值,对恶性积液诊断的敏感性分别为82.6％和71.7％,特异性分别为58.8％和82.8％,准确性分别为65.4％和76.0％;联合检测CA125和CEA诊断恶性胸腔积液的敏感性和准确性分别为93.5％和81.7％,显著高于单一检测项目（P＜O.05）.结论 联合检测胸腔积液中ADA、CEA和CA125对早期鉴别诊断结核性与恶性胸水的有重要参考价值.

Objective To assess the clinical value of combined detection of fluidadenosine deaminase （ADA）,carbohydrate antigen 125 （CA125） and carcinoembryonic antigen （CEA） in the differential diagnosis of tuberculous and malignant pleural effusion.Methods The activity of ADA in pleural effusion was determined by the method of continuous monitoring with enzyme and the levels of CA125 and CEA were detected by chemiluminescence immune analysis in both 82 patients with tuberculous pleural effusion and 56 patients with malignant pleural effusion,and the results were comprehensively analyzed.Results The average content of ADA in tuberculous pleural effusion was significantly higher than that in malignant pleural effusion,while the levels of CEA and CA125 were significantly lower than those in malignant pleural effusion （P〈0.05）.If the cut-off value of ADA was more than 40 U/L in the diagnosis of tuberculous pleural effusion,its sensitivity,specificity and accuracy were 82.8%,80.4% and 81.7% respectively.If the cut-off value of CA125 was more than 35 U/ml,the sensitivity,specificity and accuracy for diagnosis of malignant pleural effusion were 82.6%,58.8% and 65.4% respectively.If the cut-off value of CEA was more than 5μg/L,the sensitivity,specificity and accuracy for diagnosis of malignant pleural effusion were 71.7%,82.8% and 76.0% respectively.The sensitivity and accuracy of combination of CA125 and CEA for diagnosis of malignant pleural effusion was 93.5% and 81.7%,Which were higher than those of either CA125 or CEA （P〈0.05）.Conclusion The combined detection ofADA,CEA and CA125 has an important reference value for early differential diagnosis of tuberculous and malignant pleural effusion.