腺苷脱氨酶与癌胚抗原的测定在结核性与癌性胸水鉴别诊断中的意义

Clinical significance of determining adenosine deaminase and carcinoembryonic antigen in the differential diagnosis of tuberculous and carcinomatous hydrothorax

目的 :探讨腺苷脱氨酶 (ADA)与癌胚抗原 (CEA)的测定在鉴别结核性与癌性胸水中的临床意义。方法 :分别测定 116例结核性与癌性胸水患者胸水与血清中的ADA与CEA ,分析其升高的比率、诊断的敏感性、特异性 ,并进一步寻找有效准确的数值指标。结果 :结核性胸水组ADA值 (4 7 0 7± 3 12 )明显高于癌性胸水组 (2 5 13± 6 5 8) (P <0 0 5 ) ,而癌性胸水组CEA值 (3 7 5 2± 6 3 6)明显高于结核性胸水组 (3 41± 0 0 8) (P <0 0 5 ) ;ADA的敏感性为 96 2 %特异性为90 3 % ,CEA的敏感性为 70 1% ,特异性为 93 1% ;癌性胸水组的胸水CEA(PCEA) /血清CEA(SCEA)全部大于 1;2 1例腺癌中 2 0例CEA >10ng/ml,特异性达 99%。 结论 :ADA与CEA的测定在结核性与癌性胸水的鉴别中具有重要的临床意义 ,其中ADA的敏感性较高特异性较差 ,而CEA的敏感性较差、特异性较高 ;PCEA/SCEA >1对于判断癌性胸水更精确 ;CEA的测定对于腺癌具有更显著的意义。

Objective To study the clinical significance of determining adenosine deaminase(ADA)and carcinoembryonic antigen(CEA) in the differential diagnosis of tuberculous and carcinomatous hydrothorax.Methods Hydrothorax and serum ADA and CEA were determined in 116 patients with tuberculous and carcinomatous hydrothorax and analyzed the increasing ratio, diagnostic sensitivity and specificity so as to find out the valid and accurate indices. Results ADA was obviously higher in tuberculous hydrothorax patients (47.07±3.12) than in carcinomatous hydrothorax patients(25.13±6.58)(P<0 05).CEA was obviously higher in carcinomatous hydrothorax patients (37.52±6.36) than in tuberculous hydrothorax patients(3.41±0.08)(P<0.05).The sensitivity and specificity of ADA were 96.2% and 90.3%,and of CEA were 70.1% and 93.1% .CEA(PCEA)/CEA(SCEA) was larger than l in carcinomatous hydrothorax patients. CEA of 20 patients was larger than 10ng/ml in 21 patients with adenocarcinoma and its specificity was 99%.Conclusion Determination of ADA and CEA plays an impontant role in the diferential diagnosis of tuberculous and carcinomatous hydrothorax with the strong sensitivity and weak specificity of ADA,and weak sensitivity and strong specificity of CEA.The diagnosis can be more accurate for carcinomatous hydrothax when PCEA/SCEA>1.The defermination of CEA has more significance in the diagnosis of adenocarcinoma.