渗出性胸腔积液69例临床分析

Clinial analysis of 69 cases with exudative pleural effusion

目的探讨常用肿瘤标志物对良恶性胸腔积液的鉴别诊断价值。方法选取自2014年6月至2015年6月住院的69例渗出性胸腔积液患者,根据诊断结果分为良性组(39例)和恶性组(30例),对其临床资料进行比较,以ROC曲线、Logistic回归判断相关指标诊断恶性胸腔积液的价值。结果 2组在性别、胸痛、咯血、消瘦、白细胞计数、中性粒细胞比例、C-反应蛋白、胸水LDH、血清LDH,胸水/血清LDH、血清CA125方面差异无统计学意义,具有可比性;2组在年龄、发热、咳嗽、呼吸困难方面差异有统计学意义(P均<0.05);良性组血沉、胸水ADA显著高于恶性组,恶性组胸水CEA、血清CEA、胸水/血清CEA,胸水CA25,胸水/血清CA125,胸水CA199,血清CA199,胸水/血清CA199,血NSE、血Cyfra21-1均显著高于良性组。血Cyfra21-1,胸水CA125,胸水CEA曲线下面积依次为0.871,0.858,0.853。经Logistic回归分析,发热、胸水ADA升高,胸水/血清CEA≤1倾向良性胸腔积液的诊断。结论血Cy-fra21-1,胸水CA125,胸水CEA是诊断恶性胸腔积液较好的指标,发热、胸水ADA升高,胸水/血清CEA≤1倾向良性胸腔积液的诊断。

Objective To summarize the differential diagnosis of clinical presentations and tumour markers for benign or malignant pleural effusion. Methods Sixty-nine cases of hospitalized patients with pleural efusion were enrolled between June 2014 to June 2015. According to the final diagnosis,two groups were divided：benign pleural effusion（BPE）group and malignant pleural effision（MPE） group. Clinic features of the two groups were analyzed. By ROC curve and Logistic regression, the diagnostic value of different laboratory tests for MPE was evaluated. Results 1. There were not significant differences in sex, chest pain, hemoptysis, marasmus, WBC, N%, CRP, LDH and CA125 in blood between the two groups. 2. There were statistical significant diferences in age, fever, cough and dyspnea. The level of ESR and ADA was higher in the BPE group than in the MPE group. The level of CEA, CA199, NSE, Cyfra21- 1 in blood and CEA,CA125, CA199 in effusion and PCEA/SCEA, PCA125/SCA125, PCA199/SCA199 were higher in the MPE group than in the BPE group. 3. The area under ROC curve（AUC） of Cyfra21-1 in serum, CA125 in fluid and CEA in fluid for the diagnosis of MPE was 0.871,0.858,0.853 respectively.4.From Logistic regression, the valuable factors were fever, ADA in effusion and PCEA/SCEA. Conclusion Cyfra21- 1 in serum, CA125 and CEA in fluid are helpful for the diagnosis of MPE.It would lead to the diagnosis of BPE if a patient with fever, high ADA and PCEA/SCEA≤1.