肺癌并恶性胸腔积液患者血清和胸腔积液肿瘤标志物水平变化及其对良恶性胸腔积液的鉴别诊断价值研究

Change of Serum and Pleural Effusion Tumor Markers Levels in Lung Cancer Patients Complicated with Malignant Pleural Effusion and the Differential Diagnostic Value between Benign and Malignant Pleural Effusion

目的分析肺癌并恶性胸腔积液患者血清和胸腔积液肿瘤标志物水平变化及其对良恶性胸腔积液的鉴别诊断价值。方法选取2016年2月—2017年12月苏州大学附属常熟医院收治的肺癌并恶性胸腔积液患者34例作为试验组,以性别、年龄为匹配条件,按照1:1比例选取同期收治的良性胸腔积液患者34例作为对照组。对照组患者针对原发病给予对症治疗及胸腔积液引流,试验组患者给予化疗及胸腔积液引流。观察试验组患者化疗效果,比较两组患者治疗前血清和胸腔积液肿瘤标志物水平、试验组患者化疗前后及不同化疗效果患者血清肿瘤标志物水平,并绘制ROC曲线以评价治疗前胸腔积液肿瘤标志物水平对良恶性胸腔积液的鉴别诊断价值。结果 (1)试验组患者中完全缓解13例,部分缓解10例,疾病稳定5例,疾病进展6例;化疗有效23例,化疗失败11例。(2)试验组患者治疗前血清和胸腔积液细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC-Ag)水平高于对照组(P<0.05)。(3)绘制ROC曲线发现,治疗前胸腔积液CYFRA21-1、CEA、NSE、SCC-Ag水平鉴别诊断良恶性胸腔积液的曲线下面积分别为0.881[95%CI(0.716,0.928)]、0.963[95%CI(0.683,0.964)]、0.910[95%CI(0.688,0.975)]、0.926[95%CI(0.724,0.972)]。(4)试验组患者化疗后血清CYFRA21-1、CEA、NSE、SCC-Ag水平低于化疗前(P<0.05);化疗有效患者血清CYFRA21-1、CEA、NSE、SCC-Ag水平低于化疗失败患者(P<0.05)。结论肺癌并恶性胸腔积液患者血清和胸腔积液CYFRA21-1、CEA、NSE、SCC-Ag水平升高,治疗前胸腔积液CEA、NSE、SCC-Ag水平对良恶性胸腔积液的鉴别诊断价值较高,且血清CYFRA21-1、CEA、NSE、SCC-Ag水平可用于评估肺癌并恶性胸腔积液患者近期化疗效果。

Objective To analyze the change of serum and pleural effusion tumor markers levels in lung cancer patients complicated with malignant pleural effusion and the differential diagnostic value between benign and malignant pleural effusion.Methods A total of 34 lung cancer patients complicated with malignant pleural effusion were selected as test group in Changshu Hospital Affiliated to Soochow University from February 2016 to December 2017,meanwhile a total of 34 patients with benign pleural effusion were selected as control group according to matching condition of gender,age and 1:1 ratio.Patients in control group received symptomatic treatment for primary illness and drainage of pleural effusion,while patients in test group received chemotherapy and drainage of pleural effusion.Clinical effect in test group was observed,serum and pleural effusion tumor markers levels were compared between the two groups before treatment,serum tumor markers levels were compared before and after chemotherapy,in patients with different curative effect of chemotherapy,and ROC curve was drawn to evaluate the differential diagnostic value of pleural effusion tumor markers levels before treatment between benign and malignant pleural effusion.Results (1)In test group,13 cases got complete remission,10 cases got partial remission,10 cases with stable disease,and 6 cases with progressive disease;23 cases got effective effect of chemotherapy,11 cases got invalid effect of chemotherapy.(2)Serum and pleural effusion levels of CYFRA21-1,CEA,NSE and SCC-Ag in test group were statistically significantly higher than those in control group before treatment(P<0.05).(3)ROC curve showed that,AUC of pleural effusion levels of CYFRA21-1,CEA,NSE and SCC-Ag before treatment in the differential diagnosis between benign and malignant pleural effusion was 0.881〔95%CI(0.716,0.928)〕,0.963〔95%CI(0.683,0.964)〕,0.910〔95%CI(0.688,0.975)〕and 0.926〔95%CI(0.724,0.972)〕,respectively.(4)After chemotherapy,serum levels of CYFRA21-1,CEA,NSE and SCC-Ag in test group were statistically significantly lower than those before chemotherapy(P<0.05);serum levels of CYFRA21-1,CEA,NSE and SCC-Ag in patients with effective effect of chemotherapy were statistically significantly lower than those in patients with invalid effect of chemotherapy(P<0.05).Conclusion Serum and pleural effusion levels of CYFRA21-1,CEA,NSE and SCC-Ag are significantly elevated in lung cancer patients complicated with malignant pleural effusion,pleural effusion levels of CEA,NSE and SCC-Ag before treatment has relatively high differential diagnostic value between benign and malignant pleural effusion,serum levels of CYFRA21-1,CEA,NSE and SCC-Ag are helpful to evaluate the short-term curative effect of chemotherapy.