ROC工作曲线评价胸水中HE4、CEA、NSE、SCC、CYFRA21-1、ProGRP在良恶性胸腔积液中的诊断价值

ROC WORKING CURVE TO EVALUATE DIAGNOSTIC VALUE OF HE4,CEA,NSE,SCC,CYFRA21-1 AND PROGRP IN BENIGN AND MALIGNANT PLEURAL EFFUSION

目的通过ROC工作曲线综合分析胸水人附睾蛋白4(HE4)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、鳞状细胞癌抗原(SCC)、细胞角蛋白19片段(CYFRA21-1)及胃泌素释放肽前体(ProGRP)检测在肺癌胸腔积液中的诊断价值。方法采用化学发光法检测60例恶性胸腔积液、30例良性胸腔积液中HE4、CEA、NSE、SCC、CYFRA21-1、ProGRP水平,分析比较二组6项指标水平差异,寻找对恶性胸腔积液具有诊断价值的指标,将这些指标在二组中单项及联合检测的阳性率、诊断性能进行比较;采用ROC工作曲线分析各指标对恶性胸腔积液的诊断价值。结果①恶性胸腔积液组中HE4、CEA、NSE、CYFRA21-1、ProGRP指标水平明显高于良性胸腔积液组,差异均有统计学意义(Z=-3.654,P=0.000;Z=-3.419,P=0.001;Z=-2.287,P=0.022;Z=-3.226,P=0.001;Z=-2.793,P=0.005),SCC在二组之间差异无统计学意义(Z=-1.073,P=0.283)。②恶性胸腔积液组HE4、CEA、NSE、CYFRA21-1、ProGRP的阳性率明显高于良性胸腔积液组,差异有统计学意义(χ^(2)=17.79,15.00,14.01,14.46,10.17,均P<0.05)。单项的检测阳性率由高到低为:ProGRP(90.0%)>HE4(83.3%)=NSE(83.3%)>CEA(80.0%)>CYFRA21-1(66.7%),CEA+NSE+CYFRA21-1+ProGRP+HE4联合检测的阳性率为96.7%,与单项检测比较差异有统计学意义(χ^(2)=5.51,P<0.05)。③单项检测时ProGRP的灵敏度较高,HE4的特异度较高。单项检测与联合检测比较灵敏度由66.7%提高到96.7%,阴性预测值由52.4%提高到91.3%,但特异度,阳性预测值略有降低。④单项检测时ROC曲线下面积依次为HE4(0.829)、CEA(0.816)、CYFRA21-1(0.798)、ProGRP(0.758)、NSE(0.711),HE4曲线下面积最大,HE4+CEA+NSE+CYFRA21-1+ProGRP联合检测ROC曲线下面积(0.969)大于单项检测的ROC曲线下面积。结论HE4单项或联合检测时对恶性胸腔积液的诊断具有较高的临床价值。

Objective The diagnostic value of human epididymal protein 4(HE4),carcinoembryonic antigen(CEA),neuron specific enolase(NSE),squamous cell carcinoma antigen(SCC),cytokeratin 19 fragment(CYFRA21-1)and gastrin releasing peptide precursor(ProGRP)in pleural effusion of lung cancer was analyzed by ROC working curve.Methods The levels of HE4,CEA,NSE,SCC,CYFRA21-1 and ProGRP in sixty cases of malignant pleural effusion and thirty cases of benign pleural effusion were detected by chemiluminescence method.The differences of six indexes between the two groups were analyzed and compared,so as tofind the detection indexes with diagnostic value for malignant pleural effusion.The positive rate and diagnostic performance of single and combined detection of these indexes in the two groups were compared;ROC working curve was used to analyze the diagnostic value of each index in malignant pleural effusion.Results①The levels of HE4,CEA,NSE,CYFRA21-1 and ProGRP in malignant pleural effusion group were significantly higher than those in benign pleural effusion group(Z=-3.654,P=0.000;Z=-3.419,P=0.001;Z=-2.287,P=0.022;Z=-3.226,P=0.001;Z=-2.793,P=0.005),SCC was not statistically significant between the two groups(Z=-1.073,P=0.283).②The positive rates of HE4,CEA,NSE,CYFRA21-1 and ProGRP in malignant pleural effusion group were significantly higher than those in benign pleural effusion group X2=17.79,15.00,14.01,14.46,10.17,P<0.05).The positive rate of single test from high to low was ProGRP(90.0%)>HE4(83.3%)=NSE(83.3%)>CEA(80.0%)>CYFRA21-1(66.7%),and the positive rate of CEA+NSE+CYFRA21-1+ProGRP+HE4 was 96.7%,which was statistically significant compared with single test(X^(2)=5.51,P<0.05).③ProGRP has high sensitivity and HE4 has high specificity in single detection.Compared with the combined detection,the sensitivity increased from 66.7%to 96.7%,and the negative predictive value increased from 52.4%to 91.3%,but the specificity and positive predictive value decreased slightly.④In single test,the area under ROC curve is HE4(0.829),CEA(0.816),CYFRA21-1(0.798),ProGRP(0.758)and NSE(0.711).The area under HE4 curve is the largest,and the area under ROC curve(0.969)in combined test of HE4+CEA+NSE+CYFRA21-1+ProGRP is greater than that under ROC curve in single test.Conclusion HE4 single or combined detection has high clinical value in the diagnosis of malignant pleural effusion.