脑脊液肿瘤标志物检查在脑膜转移瘤诊断中的价值

The value of tumor markers in cerebrospinal fluid in the diagnosis of leptomeningeal metastasis

目的:通过分析脑膜转移瘤的临床特点、增强MRI表现、脑脊液肿瘤标志物检查结果,提高对脑膜转移瘤的认识程度,并寻找有效的检查方法。方法:回顾分析我院肿瘤内科2011年10月至2017年6月收治的23例脑膜转移瘤患者,从临床表现、脑膜增强MRI表现、脑脊液肿瘤标志物检测以及与血清肿瘤标志物进行对比的结果进行统计分析。结果:23例患者中脑脊液肿瘤标志物、细胞学和影像学阳性表达率分别为82. 61%、56. 52%和65. 22%;以单一标志物CEA为独立观察指标,当脑脊液中CEA含量高表达时,脑脊液细胞学、脑膜强化MRI的阳性检出率也增加;当脑脊液肿瘤标志物多种阳性表达时,脑脊液细胞学、脑膜强化MRI阳性率也增加,三者之间密切相关,具有统计学意义(P <0. 05)。肿瘤标志物在脑脊液中的阳性表达与在血清中呈对应关系。结论:脑脊液细胞学检查和增强MRI是脑膜转移瘤的主要诊断依据,脑脊液肿瘤标志物联合脑膜增强MRI弥补了细胞学检查的缺陷,提高诊断准确率。

Objective:By analyzing the clinical features,enhanced MRI and tumor markers in cerebrospinal fluid,we tried to improve the understanding of leptomeningeal metastasis and find effective examination methods.Methods:A retrospective analysis was performed on23patients diagnosed with meningeal carcinomatosis from2011.10to2017.6in our hospital of medical oncology.The results of clinical manifestations,meningeal enhanced MRI,detection of tumor markers in cerebrospinal fluid,and tumor markers in serum were statistically analyzed.Results:The positive expression rate of tumor marker in cerebrospinal fluid,cytological examination and image examination was82.61%,56.52%and65.22%respectively.CEA,a single tumor marker,as an independent observer,when it was high in cerebrospinal fluid,the positive rate of cytology and meningeal enhanced MRI in cerebrospinal fluid were also increased.When several tumor markers were expressed,the positive detection rate of cytological examination and abnormal changes in enhanced MRI occurrencly enhanced.The three roles were closely related and had statistically significant.The positive expression of tumor markers in the cerebrospinal fluid is corresponding to the serum.Conclusion:Cytological examination of cerebrospinal fluid and enhanced MRI are the main diagnostic basis for meningeal metastases.The combination of tumor markers in cerebrospinal fluid and MRI examination can obviously improved the accuracy of diagnosis,and made up the defects of cytological examination.