胸腔积液中CK19-2G2、CK18-3A9和间皮素检测的临床意义

目的 初步探讨胸腔积液中细胞角蛋白新型片段CK19-2G2和CK18-3A9以及间皮素的测定对良、恶性胸腔积液临床鉴别诊断价值.方法 收集34例恶性和46例良性胸腔积液,应用板式化学发光分别检测胸腔积液中CK19-2G2、CK18-3A9和间皮素的水平;通过ROC曲线下面积评价胸腔积液中这三种标志物单独或联合检测时对良、恶性胸腔积液临床鉴别诊断价值;同时评估肾功能状况对胸腔积液中CK19-2G2、CK18-3A9和间皮素水平的影响.结果 恶性组患者胸腔积液CK19-2G2水平显著高于良性组（P〈0.05）;恶性组患者胸腔积液CK18-3A9和间皮素水平与良性组比较,差异无统计学意义（P〉0.05）;CK19-2G2、CK18-3A9和间皮素单独测定时ROC曲线下面积分别为0.67、0.60、0.49,细胞角蛋白新型片段CK19-2G2和CK18-3A9联合检测ROC曲线下面积为0.62,三个标志物联合检测ROC曲线下面积为0.63;患者肾功能状况对胸腔积液中CK19-2G2、CK18-3A9和间皮素水平无显著影响.结论 胸腔积液中细胞角蛋白新型片段CK19-2G2测定对良、恶性胸腔积液的鉴别诊断具有一定的临床应用价值.

Clinical Significance of CK19-2G2,CK18-3A9 and mesothelin assay in diagnosis of pleural effusion

Objective To study the value of novel cytokeratin fragments CK19-2G2 ,CK18-3A9 and mesothelin assay for the dif ferential diagnosis of benign and malignant pleural effusions. Methods Pleural levels of CK19-2G2 and CK18-3A9 and mesothelin were assayed in 80 patients with pleural effusions （34 malignant and 46 benign） by micro-plate chemiluminescence enzyme immunoassay. Receiver operator characteristic（ROC） curves were constructed to evaluate the individual and combined diagnostic performance of the three markers for differentiating malignant pleural effusions from benign. Renal function testing was applied to evaluate the impact of the state of the kidney on the pleural level of three markers. Results The levels of CK19-2G2 in malignant pleural effusions were obviously higher than those of the benign group （P〈 0. 05）. There was no significant difference in quantities of CK18-3A9 and mesothelin in pleural effusions between the malignant and benign patients（P〈0.05）. The areas under ROC curves for CK19-2G2,CK18 3A9 and mesothelin were 0. 67,0. 60,0. 49, respectively. When CK19-2G2 and CK18-3A9 combined, the area under ROC curve was 0.62 ,while the combination of the three markers had an area under ROC curve of 0.63. The data also showed that the state of the kidney had no obvious influence on the level of CK19-2G2 and CK18-3A9 and Mesothelin in pleural effusions. Conclusion The detection of pleural CK19-2G2 has some value for differential diagnosis of benign and malignant pleural effusions.