细胞形态学检查联合血清肿瘤标志物检测对恶性胸腔积液/腹水的诊断价值

Diagnostic value of cytomorphological examination combined with serum tumor markers detection in malignant pleural effusion or ascites

目的探讨细胞形态学检查联合血清肿瘤标志物检测对恶性胸腔积液/腹水的诊断价值。方法选取该院收治的胸腔积液/腹水患者(93例,根据病理结果分为恶性组48例,良性组45例),均行细胞形态学检查和癌胚抗原(CEA)、糖类抗原199(CA199)、腺苷脱氨酶(ADA)检测,比较良恶性胸腔积液/腹水患者的细胞形态学、CEA、CA199、ADA检测阳性率,评价细胞形态学检查联合血清肿瘤标志物诊断恶性胸腔积液/腹水的效能。结果恶性组患者的细胞形态学检查阳性率(37.50%)、CEA阳性率(64.58%)、CA199阳性率(47.92%)、ADA阳性率(39.58%)高于良性组患者(0、8.89%、4.44%、6.67%),差异有统计学意义(P<0.05)。联合检测诊断恶性胸腔积液/腹水的灵敏度(91.67%)、准确性(91.40%)高于CEA(64.58%、80.64%)、CA199(47.92%、70.97%)、ADA(39.58%、65.59%)单项检测结果,差异有统计学意义(P<0.05),漏诊率(8.33%)低于CEA(35.42%)、CA199(52.08%)、ADA(60.42%)单项检测结果(P<0.05),特异度(91.11%)、误诊率(8.89%)与CEA(97.78%、2.22%)、CA199(95.56%、4.44%)、ADA(93.33%、6.67%)单项检测结果比较,差异无统计学意义(P>0.05)。结论细胞形态学检查联合血清肿瘤标志物检测可有效提高诊断恶性胸腔积液/腹水的准确性、灵敏度,为医师鉴别诊断恶性胸腔积液/腹水提供可靠的参考依据,具有重要的应用价值。

Objective To investigate the diagnostic value of cytomorphological examination combined with serum tumor markers detection in malignant pleural effusion or ascites.Methods A total of 93 patients with pleural effusion or ascites were selected.They were divided into the malignant group(48 cases)and benign group(45 cases)according to the pathological results.The cytomorphological examination and CEA,CA199 and ADA detection were performed.The positive rate of cytomorphological examination,CEA,CA199 and ADA detection were compared among the patients with benign and malignant pleural effusion and ascites,and the efficiency of cytomorphological examination combined with serum tumor markers detection in the diagnosis of malignant pleural effusion or ascites was evaluated.Results The positive rate of cytomorphological examination in the malignant group was 37.50%,the positive rate of CEA was 64.58%,the positive rate of CA199 was 47.92%,the positive rate of ADA was 39.58%,which were higher than 0,8.89%,4.44%and 6.67%in the benign group,and the differences were statistically significant(P<0.05).The sensitivity and accuracy of combined detection in the diagnosis of malignant pleural effusion or ascites were 91.67%and 91.40%respectively,which were higher than 64.58%and 80.64%of CEA,47.92%and 70.97%of CA199 and 39.58%and 65.59%of ADA single detection results,and the differences were statistically significant(P<0.05).The rate of missed diagnosis in the combined detection was 8.33%,which was lower 35.42%in CEA,52.08%in CA199 and 60.42%in ADA single detection results(P<0.05).The specificity was 91.11%,the misdiagnosis rate was 8.89%,which were 97.78%and 2.22%in CEA,95.56%and 4.44%in CA199 and 93.33%and 6.67%in ADA single detection results,but the differences were not statistically significant(P>0.05).Conclusion The cytomorphological examination combined with serum tumor markers detection can effectively improve the accuracy and sensitivity in the diagnosis of malignant pleural effusion or ascites,provide the reliable reference for physicians to identify malignant pleural or ascites,and has an important application value.