多指标检测对胸腔积液鉴别诊断的价值

The Clinical Value of ADA,CA153 and CEA Combination Detection in the Differential Diagnosis of Pleural Effusion

目的 探讨单项及联合检测胸腔积液腺苷脱氨酶 (ADA )、糖链抗原 15 3 (CA 15 3 )和癌胚抗原 (CEA )对良、恶性胸腔积液鉴别诊断的价值。方法 对 79例胸腔积液采用全自动化学发光免疫分析技术进行ADA、CA 15 3和CEA含量测定。根据最终诊断结果分为 3组 :恶性胸腔积液组 3 5例 ;结核性胸腔积液组 3 6例 ;其它良性胸腔积液组 8例。结果 以胸腔积液ADA≥ 40IU /L为阳性判定标准 ,对结核性胸腔积液诊断的敏感度、特异度和Youden指数分别为 83 .3 %、81.4%和 0 .64 7;以胸腔积液ADA<40IU /L、CA 15 3 >3 5kU /L和CEA >10 μg/L为阳性判定标准 ,胸腔积液ADA、CA15 3和CEA诊断恶性胸腔积液的敏感度分别为 68.6%、60 .0 %和 65 .7% ;特异度分别为 90 .9%、88.6%和 84.1% ;Youden指数分别为 0 .5 95、0 .486和 0 .498;胸腔积液ADA、CA 15 3和CEA中 2项或 3项联合检测 (串联实验 ) ,可显著提高其诊断恶性胸腔积液的特异度和Youden指数。结论 胸腔积液ADA、CA 15 3和CEA单项或联合检测 ,在良、恶性胸腔积液鉴别诊断中均有较大的价值。

Objective To study the value of the detection of adenosine deaminase(ADA),carbohydrate antigen153(CA153) and carcinoembryonic antigen(CEA) combinning detection in the differential diagnosis of benign and malignant pleural effusion.Methods With full automatic chemiluminesene immunoanology,the hydrothorax ADA,CA153 and CEA were detected in 79 patiens with pleural effusion.Based on the last diagnosis,the 79 cases were divided into three groups:malignat group(35 cases),tuberculous group(36 cases) and other benign group(8 cases).Results With hydrothorax ADA≥40 IU/L as positive judgement standard,the sensitivity,specificity and Yonden Index for tuberculous was 83.3%,81.4%,and 0.647 respectively;With the hydrothorax ADA<40 IU/L,CA153>35 kU/L and CEA>10 μg/L as positive judgement standard,the sensitivity of the hydrothorax ADA,CA153,CEA for malignant effusion was 68.6%,60.0% and 65.7% respectively,specificity was 90.9%,88.6% and 84.1% respectively,Yonden Index was 0.595,0.486 and 0.498 respectively;The specificity and Youden Index could be improved significantly in case of that two or three items of the hydrothorax ADA,CA153,CEA were detected combinned(series test).Conclusion The detection of the hydrothorax ADA,CA153 and CEA sole or combinning is useful for the differential diagnosis.