内科胸腔镜联合肿瘤标志物在不明性质胸腔积液中的诊断价值

The Diagnostic Value of Medical Thoracoscopy Combined with Tumor Marker in the Diagnosis of Pleural Effusion of Unknown Nature

目的探讨内科胸腔镜联合肿瘤标志物在不明性质的胸腔积液中的诊断价值。方法选取2014年5月至2017年5月我院门诊收治的60例原因不明胸腔积液患者进行研究。根据不同的诊断方法,分为观察组(n=30)和对照组(n=30)。对照组采用血清肿瘤标志物检测联合胸腔穿刺诊断。观察组采用血清肿瘤标志物检测联合内科胸腔镜检查诊断。观察胸腔镜下良恶性胸腔积液的特点,比较良、恶性胸腔积液患者血清肿瘤标志物水平及不同病理类型胸腔积液患者血清肿瘤标志物水平,比较两组患者的诊断学指标,观察并记录两组患者并发症发生情况。结果观察组灵敏度、特异度及准确度均显著高于对照组(P<0.05)。恶性胸腔积液患者血清CA125、SCC-Ag及CYFRA21-1水平显著高于良性胸腔积液患者(P<0.05)。非小细胞肺癌胸腔积液患者血清CA125、SCC-Ag水平显著高于小细胞肺癌胸腔积液患者(P<0.05),而非小细胞肺癌胸腔积液患者血清CYFRA21-1水平显著低于小细胞肺癌胸腔积液患者(P<0.05)。两组并发症发生率无统计学差异(P>0.05)。结论内科胸腔镜联合肿瘤标志物可显著提高不明性质胸腔积液的检出率和诊断准确率,在鉴别胸腔积液良恶性上具有重要应用价值。

Objective To investigate the diagnostic value of medical thoracoscopy combined with tumor markers in the diagnosis of pleural effusion with unknown nature. Methods From May 2014 to May 2017, 60 patients with pleural effusion with unknown nature in our hospital were studied. According to the different diagnosis methods, all patients were divided into the observation group（n=30） and control group（n=30）. The control group were examined by serum tumor markers combined with pleural puncture.The observation group wereperformedwith tumor markers combined thoracoscopic diagnosis. To observe the characteristics of thoracoscopic benign and malignant pleural effusion, serum levels of tumor markers of benign and malignant pleural effusion and different pathological types of pleural effusion were compared, diagnostic indexes of the two groups of patients were compared, and the complications of two groups were compared. Results The sensitivity, specificity and accuracy of the observation group were significantly higher than those in control group（P〈0.05）.The serum CA125, SCC-Ag and CYFRA21-1 levels of malignant pleural effusion patients were significantly higher than those of benign pleural effusion patients （P〈0.05）. The serum CA125, SCC-Ag levels of pleural effusion in patients with non small cell lung cancer were significantly higher than those of pleural effusion in patients with small cell lung cancer （P〈0.05）, and CYFRA21-1 level was significantly lower than that of pleural effusion in patients with small cell lung cancer （P〈0.05）. The complication rate of two groups had no significant difference（P〉0.05）. Conclusion The medical thoracoscopy combined with tumor markers can significantly improve the detection rate and diagnostic accuracy of unknown pleural effusion.In the differential diagnosis of benign and malignant pleural effusion has important application value.