胸腔积液肿瘤标记物检测的临床价值探讨

Clinical value of tumor markers detection in pleural effusion

目的:探讨癌胚抗原(CEA)、癌抗原125(CA-125)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)联合血管内皮生长因子(VEGF)对鉴别良恶性胸腔积液的作用.方法:选取2015-01/2016-06广西医科大学附属肿瘤医院70例初诊CT发现恶性胸腔积液的患者,治疗前抽取一次胸腔积液留取标本,采用酶联免疫吸附试验(ELISA)测定CEA、CA-125、NSE、CYFRA21-1、VEGF水平.最终选取62份标本进行分析,通过ROC曲线计算出各指标诊断恶性胸腔积液的cut-off(临界值),计算各指标单独及联合对于恶性胸腔积液诊断的敏感性、特异性及准确性.结果:70例患者经活检(胸水细胞学、纤维支气管镜或经皮穿刺活检+随访)确诊,其中原发肺癌胸膜转移38例(其中腺癌25例,鳞癌11例,小细胞癌2例),良性胸腔积液24例,最后共62例胸腔积液标本纳入研究.其中恶性胸腔积液中CEA、CA-125、CYFRA21-1、VEGF标记物明显高于良性组,差异有统计学意义(P<0.05),单独检测CEA、CA-125、CYFRA21-1、NSE、VEGF对恶性胸水的敏感性分别为78.9%,71.1%,71.1%,52.6%,78.9%,特异性为83.3%,58.0%,87.5%,66.6%,79.2%.联合各个指标对恶性胸腔积液的敏感性及特异性进行统计,可观察到最佳组合为CEA+CYFRA21-1+VEGF,敏感性及特异性为100%和84.2%,曲线下面积(AUC)为0.962,具有非常好的诊断效能.结论:测定胸腔积液中CEA+CYFRA21-1+VEGF浓度对鉴别良、恶性胸腔积液有一定价值,可以作为有用的肿瘤标记物测定组合,具有较高的敏感性、准确性及诊断效能,值得在临床推广应用.

AIM： To evaluate the individual and combined diagnostic value of earcinoembryonic antigen （ CEA ） , cancer antigen 125 （ CA-125）, neuron specific enolase （NSE） and cytokeratin 19 fragment （CYFRA21-1） combine with vascular endothelial growth factor （VEGF） in the blood and pleural fluid of patients with benign and malignant pleural effusion. METHODS： A total of 70 patients with pleural effusion diagnosed by CT in Affiliated Tumor Hospital of Guangxi Medical University from January to June 2016 were enrolled in this study. Before the treatment, the samples were collected from pleural effusion, and the levels of CEA, CA-125, NSE, CYFRA21-1 and VEGF were measured by enzyme linked immunosorbent assay （ELISA）. Finally, 62 samples were selected for analysis. The cut-off values （critical value） of malignant pleural effusion were calculated by ROC curve. The sensitivity, specificity and accuracy of the indexes were calculated separately and in combination for the diagnosis of malignant pleural effusion. RESULTS： A total of 70 patients were diagnosed with biopsy （pleural effusion cytology, fiberoptie bronchoscopy and pereutaneous biopsy and follow-up ）, Among them, 38 cases of primary lung cancer pleural metastasis （25 eases of adenocarcinoma, 11 cases of squamous cell carcinoma, 2 cases of small cell carcinoma） , 24 cases of benign pleural effusion. Finally, 62 cases of pleural effusion specimens were included in the study. The CEA, CA-125, CYFRA21-1, VEGF of the malignant pleural effusion were significantly higher than those of benign group, with statistically significant differences （ P 〈 0.05 ）. The sensitivity of CEA, CA-125, CYFRA21-1, NSE and VEGF was 78.9%, 71.1%, 71.1%, 52.6%, 78.9%, and the specificity was 83.3%, 58.0%, 87.5%, 66.6%, 79.2% respectively. The combined diagnosis of CEA, CA-125, CYFRA21-1, NSE and VEGF showed that CEA＋CYFRA21-1＋VEGF had an highest diagnositic efficiency. The sensitivity was 100%, and specificity was 84.2%. Area under the curve was 0.962, and it had a good effect of diagnosis. CONCLUSION： The results suggest that the assay of CEA＋CYFRA21-1＋VEGF might be useful in the differentiation between benign and malignant pleural effusion, which can be used as a useful tumor marker combination, with high sensitivity, accuracy and diagnostic efficacy, and it is worthy of clinical application.