胸腔积液与血清中的癌胚抗原及其比值对结核性与肺癌性胸腔积液的诊断价值

Detection of carcinoembryonic antigen levels in pleural effusion and serum and their ratio for differential diagnosis of pleural effusion resulting from tuberculosis and lung cancer

目的探讨联合检测胸腔积液癌胚抗原(PCEA)和血清癌胚抗原(SCEA)以及二者比值(PCEA/SCEA,P/S)在鉴别结核性与肺癌性胸腔积液中的临床诊断价值。方法选取并收集我院2016年4月～2018年3月收治的临床确诊的82例结核性胸腔积液液患者(对照组)和120例肺癌性胸腔积患者(试验组)的胸腔积液和血清进行CEA水平检测,计算出P/S值,再将试验组按照不同病理类型分成鳞癌、腺癌和小细胞癌3个亚组进行组间和组内比较,以测得各组间检测指标的水平差异。创建受试者工作特征曲线(ROC曲线)进行分析以确定诊断肺癌性胸腔积液的最佳临界值,以其为诊断标准,计算出单项检测以及联合检测的诊断性能。结果肺癌组和3个亚组的PCEA、SCEA以及P/S水平均高于结核组(P<0.05);3项指标的ROC曲线下面积分别为0.925、0.866和0.796,以PCEA为最高,其灵敏度、特异度、准确率、最佳临界值分别为:83.33%、96.34%、88.61%、3.26 ng/mL;SCEA诊断性能最低,但具有取材简便、无创伤的优点;P/S诊断性能高于SCEA、低于PCEA,但与SCEA联合诊断后可大大提高诊断性能,减少误诊和漏诊;并联试验中的三者联合检测的敏感度均高于单项和两两联合检测(P<0.05),特异度无统计学差异;三者联合诊断肺癌性胸腔积液的曲线下面积为0.941,均高于单项和两两联合检测。结论在肯定PCEA诊断优势的同时,也要考虑到SCEA和P/S的不可或缺性。PCEA、SCEA和P/S三者联合检测对肺癌性胸腔积液的诊断有较高的敏感性,对疑似病例的快速、准确的鉴别诊断具有重要的辅助价值。

Objective To study the clinical value of detecting carcinoembryonic antigen levels in pleural effusion (PCEA) and serum (SCEA) and their ratio (P/S) in the differential diagnosis of pleural effusions resulting from tuberculosis and lung cancer. Methods This retrospectively study was conducted among 82 patients with pleural effusion caused by pulmonary tuberculous (TB;control group) and 120 patients with pleural effusion resulting from lung cancer in our hospital between April, 2016 and March, 2018. PCEA, SCEA and P/S were compared between the two groups and among the subgroups of lung cancer patients with squamous cell carcinoma (SqCa), adenocarcinoma (ACA), small cell carcinoma (SCLC). The receiveroperating characteristic curve (ROC) analysis was used to confirm the optimal critical value to evaluate the diagnostic efficiency of different combinations of PCEA, SCEA and P/S. Results PCEA, SCEA and P/S were significantly higher in the overall cancer patients and in all the 3 subgroups of cancer patients than in the patients with TB (P<0.05). The areas under the ROC curve of PCEA, SCEA and P/S were 0.925, 0.866 and 0.796, respectively;PCEA had the highest diagnostic value, whose diagnostic sensitivity, specificity, accurate rate, and diagnostic threshold were 83.33%, 96.34, 88.61%, and 3.26 ng/ml, respectively;SCEA had the lowest diagnostic performance;the diagnostic performance of P/S was between that of SCEA and PCEA, but its combination with SCEA greatly improved the diagnostic performance and reduced the rates of misdiagnosis and missed diagnosis. Parallel tests showed that the 3 indexes combined had significantly higher diagnostic sensitivity than each or any two of the single indexes (P<0.05), but the diagnostic specificity did not differ significantly. The area under the ROC curve of combined detections of the 3 indexes was 0.941 for diagnosis of lung cancer-related pleural effusion, higher than those of any other combinations of the indexes. Conclusion The combined detection of PCEA, SCEA and P/S has a high sensitivity for diagnosis of lung cancer-related pleural effusion and provides important information for rapid and accurate diagnosis of suspected cases.