胸水HIF-1α和Cav-1对肺腺癌胸腔积液的诊断价值

Diagnostic value of pleural fluid HIF-1α and Cav-1 in lung adenocarcinoma pleural effusions

目的分析HIF-1α和Cav-1鉴别诊断肺腺癌胸腔积液(LA-MPE)和结核性胸腔积液(TBPE)的价值并与癌胚抗原(CEA)比较。方法选择2013年1月—2015年12月本院收治的30例LA-MPE和29例TBPE患者作为研究对象,收集临床患者资料和胸水标本,ELISA法测定胸水HIF-1α、Cav-1浓度,分析与CEA、CA125相关性,ROC曲线分析HIF-1α、Cav-1诊断LA-MPE敏感性、特异性及与CEA联合检测的价值。结果LA-MPE组胸水HIF-1α、Cav-1水平明显高于TBPE组[HIF-1α:(117.58±53.09)pg/ml vs(81.33±23.45)pg/ml;Cav-1:(95.02±50.28)pg/ml vs(53.67±23.48)pg/ml](P<0.05),CEA水平也明显高于TBPE组(P<0.01);CA125水平无显著差异。HIF-1α、Cav-1与CEA显著正相关(P<0.01),两者诊断敏感性、特异性分别为77.4、65.5%,64.5、75.9%;截断值分别为100.97、57.76 pg/ml;截断值为56.18 ng/ml时,CEA诊断敏感性、特异性为87.1%、83.7%。HIF-1α联合Cav-1增强了LA-MPE诊断效能,而HIF-1α、Cav-1和CEA三者组合诊断效率最高。结论检测胸水HIF-1α、Cav-1有助于鉴别LA-MPE和TBPE,两者联合CEA将增加LA-MPE诊断准确性。

Objective To assess the diagnostic value of HIF-1αand Cav-1 in the pleural fluid in distinguishing lung adenocarcinoma pleural effusions(LA-MPE)and tuberculous pleural effusions(TBPE)and comparison with results of carcinoembryonic antigen(CEA).Methods From January 2013 to December 2015,30 cases of patients with LA-MPE and 29 cases of patients with TBPE those admitted to hospital were enrolled as study subjects.Clinic data and pleural effusion samples were collected from patients,HIF-1αand Cav-1 levels were measured by ELISA and their correlation to CEA and CA 125 were subsequently assessed.Receiver operator characteristic curve analysis was performed to evaluate the sensitivity and specificity of HIF-1α,Cav-1 and CEA in diagnosing LA-MPE.In addition,the clinical value of a combination of these markers was assessed.Results Pleural HIF-1α,Cav-1 levels were significantly increased in LA-MPE group compared with TBPE group[HIF-1α:(117.58±53.09)pg/ml vs(81.33±23.45)pg/ml;Cav-1:(95.02±50.28)pg/ml vs(53.67±23.48)pg/ml](P<0.05).Mean levels of CEA were also found to be significantly higher in LA-MPE group than in TBPE group(P<0.01).No statistical difference was found in pleural fluid CA 125 between LA-MPE and TBPE group.HIF-1α,Cav-1 levels were significantly correlated with CEA(P<0.01).The diagnostic sensitivity and specificity of HIF-1α,Cav-1 were 77.4%and 65.5%,64.5%and 75.9%,respectively;The optimal cutoff values were 100.97 and 57.76 pg/ml,respectively.When the cutoff value was 56.18 ng/ml,the sensitivity and specificity of CEA were 87.1%and 83.7%,respectively.The combination of HIF-1αand Cav-1 enhanced diagnostic performance with respect to LA-MPE,while HIF-1α,Cav-1 combined with CEA presented the highest diagnostic efficiency.Conclusions The detection of HIF-1α,Cav-1 in pleural fluid is informative for distinguishing LA-MPE from TBPE.The combination of the two indicators plus CEA may improve diagnostic accuracy in LA-MPE.