联合检测血管内皮生长因子和癌胚抗原对诊断良、恶性胸腔积液的价值

The value of combined detection of VEGF and CEA in the diagnosis of benign/malignant pleural effusion

目的评价联合检测血管内皮生长因子(vascular endothelial growth factor,VEGF)和癌胚抗原(carcinoembryonic antigen,CEA)对于恶性胸腔积液(malignant pleural effusion,MPE)的诊断价值。方法共收集65例胸腔积液患者的胸腔积液及血清标本,35例为MPE,另外30例良性胸腔积液(benign pleural effusion,BPE)。通过logistic回归按照各因子浓度构建诊断模型,按适当权重将VEGF和CEA浓度加和,分别计算胸腔积液VEGF/CEA和血清VEGF/CEA并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估上述诊断模型的诊断价值。通过比较ROC曲线下面积(area under curve,AUC)的改变评估联合诊断VEGF或CEA对MPE的诊断效能。结果 3个单独指标(胸腔积液VEGF、血清VEGF、胸腔积液CEA)AUC均在90%左右,具有良好的诊断效能,但敏感度较差(80%、74.29%、71.43%);胸腔积液VEGF/CEA和血清VEGF/CEA将敏感度提高到88.57%。两个联合诊断指标对单独指标的诊断效能均有提高(ΔAUC>0),胸腔积液VEGF/CEA提高得并不显著,血清VEGF/CEA则有显著提升。结论联合VEGF和CEA有助于诊断MPE。

Objective To evaluate the ability of combined detection of vascular endothelial growth factor(VEGF) and carcinoembryonic antigen(CEA) in diagnosis of malignant pleural effusion(MPE). Methods Sixty-five consecutive pleural effusion(PE) patients were enrolled. The combined diagnostic value of pleural effusion VEGF/CEA and serum VEGF/CEA were analyzed by weighting the VEGF and CEA concentrations. The ROC curves were drawn to assess the combined diagnostic value of them. The diagnostic efficacies of pleural effusion VEGF/CEA, serum VEGF/CEA, VEGF or CEA for MPE by comparing changes in AUCs. Results AUCs of three individual indicators(pleural effusion VEGF, serum VEGF, pleural effusion CEA) were around 90%, with good diagnostic performance, but the sensitivity were poor(80%, 74.29%, 71.43%, respectively). Pleural effusion VEGF/CEA and serum VEGF/CEA improved the diagnostic sensitivity to 88.57%. Diagnostic efficacy of the two combined diagnostic indicators for individual indicators was improved(ΔAUC>0). The increase in pleural effusions VEGF/CEA was not significant, whereas in serum VEGF/CEA, it was significantly improved. Conclusion The combination of VEGF and CEA for diagnosis of MPE could improve diagnostic performance, especially improve the sensitivity.