胸水CEA及CA125水平升高在渗出性胸腔积液诊治中的意义

The significance of elevated CEA and CA125 levels in exudative pleural effusion

目的探讨胸水癌胚抗原(CEA)和糖类抗原125(CA125)水平升高在常见渗出性胸腔积液诊治中的意义。方法回顾性分析渗出性胸腔积液患者187例,其中良性渗出性胸腔积液患者103例(包括结核性胸腔积液67例、肺炎旁性胸腔积液及脓胸36例两种类型),恶性渗出性胸腔积液患者84例。比较良恶性及不同类型良性渗出性胸腔积液患者胸水CEA、CA125及临床资料的差异。以胸水CEA 0~5ng/L为正常标准,将良性渗出性胸腔积液患者分为胸水CEA水平升高异常21例(胸水CEA异常组)和正常82例(胸水CEA正常组),比较两组患者临床特征及检验指标。结果恶性渗出性胸腔积液患者年龄、胸水CEA及CA125水平均高于良性渗出性胸腔积液患者,差异均有统计学意义(均P<0.05)。肺炎旁性胸腔积液及脓胸患者胸水CEA水平高于结核性胸腔积液患者,胸水CA125水平低于结核性胸腔积液患者,差异均有统计学意义(均P<0.05)。胸水CEA异常组肺炎旁性胸腔积液及脓胸患者比例、胸水中性粒细胞数、胸水腺苷脱氨酶、胸水乳酸脱氢酶、血白细胞和血中性粒细胞数均明显高于胸水CEA正常组,差异均有统计学意义(均P<0.05)。结论部分肺炎旁性胸腔积液及脓胸患者胸水CEA水平可出现升高,临床工作中需避免误诊;胸水CA125水平在良恶性渗出性胸腔积液中均可升高,若在良性渗出性胸腔积液中明显升高,需考虑结核性胸腔积液可能大。

Objective To investigate the significance of elevated CEA and CA125 levels in exudative pleural effusion.Methods Clinical data of 187 patients with exudative pleural effusion,including 103 cases of benign pleural effusion(67 cases of tuberculous pleural effusion,36 cases of parapneumonic pleural effusion and empyema),84 cases of malignant pleural effusion,were retrospectively reviewed.The differences and significance of pleural fluid CEA and CA125 between benign and malignant pleural effusion were analyzed.Results The age of patients,CEA and CA125 levels in malignant pleural effusion were significantly higher than those in benign pleural effusion(all P<0.05).The CEA level in parapneumonic pleural effusion and empyema was higher than that in tuberculous pleural effusion,and the CA125 level of pleural effusion was lower than that of tuberculous pleural effusion(both P<0.05).In patients with benign pleural effusion,the proportion of parapneumonic pleural effusion and empyema patients,the number of neutrophils,ADA,LDH in pleural effusion,the white cell and neutrophil in blood in the abnormal pleural fluid CEA group were significantly higher than those in the normal pleural fluid CEA group(all P<0.05).Conclusion Pleural fluid CEA level may be elevated in patients with parapneumonic pleural effusion and empyema,misdiagnosis should be avoided.The pleural fluid CA125 can be elevated in both benign and malignant pleural effusions;if it is significantly elevated in benign pleural effusion,tuberculous pleural effusion should be considered.