生物标志物联合CD133^+细胞数量对良恶性胸腔积液鉴别诊断与治疗效果评估的临床研究

The Value of Biomarker Combined with CD133^+ Cell Counter Detection in the Differential Diagnosis and Clinical Effect Evaluation of Benign and Malignant Pleural Effusion

目的探讨应用腺苷脱氨酶(ADA)、C-反应蛋白(CRP)、癌胚抗原(CEA)、糖类抗原(CA125)、CD133^+细胞和结核分枝杆菌噬菌体生物扩增(TB-PhaB)检测对结核性胸腔积液与肺癌伴胸腔积液的鉴别诊断与临床疗效评估的应用价值。方法选取我院收治的胸腔积液患者40例,其中结核性胸腔积液18例,肺癌伴胸腔积液22例。检测胸水中ADA、CRP、CEA、CA125水平和TB-PhaB阳性率,分析其对于良恶性胸水鉴别诊断的价值,并分析CD133^+细胞与恶性胸腔积液临床疗效的相关性。结果结核性胸腔积液组ADA、CRP、CEA、CA125水平分别为(42.93±15.95)U·L^(-1)、(32.61±8.73)mg·L^(-1)、(1.61±0.52)ng·m L^(-1)、(532.61±195.46)U·m L^(-1),TB-PhaB阳性率为55.6%,恶性胸腔积液组ADA、CRP、CEA、CA125水平分别为(16.95±8.76)U·L^(-1)、(12.57±7.03)mg·L^(-1)、(246.29±115.82)ng·m L^(-1)、(1032.79±315.27)U·m L^(-1),未检测到TB-PhaB阳性者,两组比较差异有统计学意义(P<0.05)。CRP、ADA、CA125、CEA曲线下面积分别为0.919、0.905、0.957、0.882,检测的灵敏度为94.9%、76.1%、90.2%、91.9%,特异度为91.3%、94.3%、71.3%、94.7%。肺癌伴胸腔积液组治疗后CR 0例,PR 8例,SD 9例,PD 5例,有效率为36.4%;PR、SD、PD患者胸腔积液中CD133^+细胞数中位值分别为2(0~31)、35(0~317)、285(15~1097)个/10 m L,差异有统计学意义(χ2~=7.317,P<0.05)。结论采用ADA、CRP、CEA、CA125、CD133^+细胞和TBPhaB检测可较好地鉴别良、恶性胸腔积液,对肺癌伴胸腔积液患者的临床疗效评估与预测具有积极价值。

Objective To explore the value of adenosine deaminase （ADA）, C-reactive protein （CRP）, carcinoembryonic antigen （CEA）, carbohydrate antigen （CA125）, CD133＋ and phage phage amplification of mycobacterium tuberculosis （TB-PhaB） detection in the differ-ential diagnosis and clinical effect evaluation of tuberculous pleural effusion and lung cancer with pleural effusion. Methods 40 patients with pleural effusion were enrolled in this study, and divided into tuberculous pleural effusion group （n=18） and lung cancer with pleural effusion group （n=22）. The detection of ADA, CRP, TB-PhaB, CEA, CA125 were carried out and the relationship between the CD133＋ cell and clinical efficacy was explored. Results The levels of ADA, CRP, CEA and CA125 in patients with tuberculous pleural effusion were respectively （42.93±15.95） U · L-1, （32.61±8.73） mg · L-1, （1.61±0.52） ng · mL-1, （532.61±195.46） U · mL-1, while those of lung cancer pa-tients with pleural effusion were respectively （16.95±8.76） U · L-1, （12.57±7.03） mg · L-1, （246.29±115.82） ng · mL-1 and （1032.79±315.27） U · mL-1. All were significantly different between the two groups （P〈0.05）. The positive rate of TB-PhaB in patients with tuberculous pleu-ral effusion was 55.6%. No positive TB-PhaB was found in lung cancer patients with pleural effusion. The area under ROC curves of CRP, ADA, CA125, CEA were respectively 0.919, 0.905, 0.957, 0.882. The sensitivity of CRP, ADA, CA125, CEA were respectively 94.9%, 76.1%, 90.2%, 91.9%, and specificity were respectively 91.3%, 94.3%, 71.3%, 94.7%. After treatment, there were 8 cases of PR, 9 cases of SD, 5 cases of PD, and no cases of CR in lung cancer patients with pleural effusion. The median numbers of CD133＋ cells in the PR, SD, PD patients were respectively 2 （0～31）, 35 （0～317）, 285 （15～1097） /10 mL, and the difference was significant （χ2=7.317, P〈0.05）. Conclu-sion The detection of ADA, CRP, CEA, CA125, CD133＋ cells and TB-PhaB can differentiate the benign and malignant pleural effusion and predict the clinical efficacy of treatment on lung cancer patients with pleural effusion.