多项肿瘤标记物检测在良恶性胸水鉴别及肺癌诊断中的应用

Tumor markers detection in pleural effusions diagnosis

目的探讨多项肿瘤标记物联合检测在良恶性胸水鉴别及肺癌诊断中的应用。方法采用电化学发光法检测石家庄市第一医院2012年3月至2014年3月共110例患者(因胸水待查收治入院)胸水中肿瘤标记物糖蛋白抗原199(CA199)、糖蛋白抗原125(CA125)、癌胚抗原(CEA)、神经元特异度烯醇化酶(NSE)、细胞角蛋白-19片段抗原(CYFRA21-1)含量,并比较多项肿瘤标记物联合检测在鉴别良恶性胸水应用中的灵敏度与特异度。结果良性胸水组患者胸水中肿瘤标记物的值均在正常值内,恶性胸水组患者胸水中CA199、CA125、CEA、NSE、CYFRA21-1含量分别为(68.2±9.3)U/ml、(66.5±10.7)U/ml、(127.6±25.6)ng/ml、(27.8±3.6)ng/ml、(76.4±8.3)ng/ml,均显著高于良性胸水组患者,差异有统计学意义(P<0.05);CA199+CA125+CEA+NSE+CYFRA21-1联合检测可将灵敏度提高至85.0%,特异度可达到96.0%,阳性预测值为96.2%,阴性预测值为84.2%,均高于单项检测。结论胸水中肿瘤标记物联合检测可提高恶性胸水的诊断率,减少漏诊及误诊的发生,值得临床推广应用。

Objective To investigate the application of combined detection of tumor markers in differential diagnosis of benign and malignant pleural effusion. Methods From March 2012 to March 2014, a total of 110 patients in our hospital with pleural effusion were analyzed for the tumor markers carbohydrate antigen 199（CA199）, CA125,carcinoembryonic antigen（CEA）, neuron-specific enolase（NSE）, and cytokerantin-19-fragment（CYFRA21-1） by chemiluminescence.The sensitivity and specificity of these tumor markers were compared. Results Patients with benign pleural effusion had normal levels of tumor markers, while the patients with malignant pleural effusion had significantly higher levels of CA199 [（68.2±9.3）U / ml], CA125 [（66.5±10.7）U / ml], CEA [（127.6±25.6）ng / ml], NSE [（27.8±3.6）ng / ml] and CYFRA21-1 [（76.4±8.3）ng / ml].The difference was statistically significant（P〈0.05）. The sensitivity, specificity, positive prediction value and negative prediction value of CA199, CA125, CEA, NSE and CYFRA21-1 combined detection were85.0%, 96.0%, 96.2% and 84.2%, respectively, and were all higher than those of individual markers. Conclusion Detection of combined tumor markers may improve the diagnosis of malignant pleural effusion, reducing the incidence of missed diagnosis and misdiagnosis, which is worthy of clinical application.