脱落细胞DNA倍体分析联合肿瘤标志物对良、恶性胸腹水的诊断价值

DNA ploidy analysis of exfoliated cells combined with tumor markers detection in differential diagnosis between benign and malignant pleural effusion or ascites

目的探讨脱落细胞DNA倍体分析联合肿瘤标志物对良、恶性胸腹水的诊断价值。方法收集永康市第一人民医院2020年1月至2022年1月收治的93例胸腹水患者。收取患者腹水进行细胞学病理诊断和脱落细胞Feulgen染色DNA定量分析。采集患者静脉血血清,采用化学发光免疫分析技术测定糖类抗原(CA)125、CA153和癌胚抗原(CEA)。观察脱落细胞DNA倍体分析准确率,计算血清肿瘤标志物阳性率,分析脱落细胞DNA倍体分析联合肿瘤标志物诊断恶性胸腹水的灵敏度和特异度。结果脱落细胞DNA倍体分析发现,恶性胸腹水38例,良性胸腹水55例,检测恶性胸腹水准确率为95.00%(38/40)。恶性胸腹水组CA125、CA153和CEA阳性率高于良性胸腹水组(P<0.05)。脱落细胞DNA倍体分析联合肿瘤标志物诊断恶性胸腹水灵敏度和特异度高于脱落细胞DNA倍体分析或肿瘤标志物单项检测(P<0.05)。结论脱落细胞DNA倍体分析联合肿瘤标志物诊断恶性胸腹水灵敏度和特异度均良好,可提高诊断价值。

Objective To assess the application of DNA ploidy analysis of exfoliated cells combined with tumor marker detection in differential diagnosis between benign and malignant pleural effusion or ascites.Methods Ninety three patients with pleural effusion or ascites admitted in Yongkang First People's Hospital from January 2020 to January 2022 were enrolled in the study.The exfoliated cells were isolated from pleural effusion or ascites,cytological and pathological diagnosis was performed,and DNA ploidy was analyzed with feulgen staining.Serum CA125,CA153 and CEA levels were determined by chemiluminescence immunoassay.Using cytological and pathological results as good standard,the sensitivity and specificity of DNA ploidy analysis with tumor marker detection in differential diagnosis of benign and malignant pleural effusion or ascites were analyzed.Results There were 40 cases of malignant and 53 cases of benign pleural effusion or ascites as confirmed by pathology or histology.In DNA ploidy analysis of exfoliated cells,there were 38 cases of malignant pleural and ascites and 55 cases of benign pleural and ascites,with a sensitivity for malignancy of 95.00%(38/40).The positive rates of CA125,CA153 and CEA was higher in malignant cases than those in benign cases(P<0.05).The sensitivity and specificity of exfoliated cell DNA ploidy analysis combined with tumor markers in differential diagnosis of malignant pleural effusion or ascites were significantly higher than those of exfoliated cell DNA ploidy analysis and tumor markers alone(P<0.05).Conclusion DNA ploidy analysis combined with tumor marker detection can improve in the differential diagnosis between malignant and benign pleural effusion or ascites.