胸腔积液及血清C-反应蛋白联合检测在恶性胸腔积液诊断中的价值

目的探讨联合检测胸腔积液及血清C-反应蛋白（CRP）水平在恶性胸腔积液诊断中的价值。方法比较60例恶性胸腔积液、46例结核性胸腔积液和35例类肺炎性胸腔积液患者的胸腔积液、血清CRP水平,分析胸腔积液CRP与血清CRP水平之间、胸腔积液CRP与癌胚抗原（CEA）水平之间、血清CRP与CEA水平之间的相关关系,以及胸腔积液和血清CRP水平诊断恶性胸腔积液的灵敏度、特异度。结果恶性组胸腔积液及血清CRP水平均低于结核组和类肺炎性组;胸腔积液CRP水平与血清CRP水平呈正相关（r=0.537,P〈0.001）;胸腔积液CRP水平与胸腔积液CEA水平呈负相关（r=-0.511,P〈0.001）;血清CRP水平与血清CEA水平呈负相关（r=-0.332,P〈0.001）。胸腔积液CRP〈20mg/L和血清CRP〈10mg/L对诊断恶性胸腔积液的灵敏度分别为68.3%、93.3%,特异度分别为93.8%、92.6%;胸腔积液CRP〈20mg/L且血清CRP〈10mg/L对诊断恶性胸腔积液的灵敏度为61.7%,特异度为97.5%。结论联合检测胸腔积液及血清CRP水平可作为良恶性胸腔积液鉴别的有用指标。

Diagnosis value of pleural effussion and serum level of C-reactive protein combined detection for malignant pleural effussion

Objective To investigate the value of pleural effussion and serum level of C-reactive protein(CRP) combined detection in differential diagnosis for malignant pleural effussion.Methods Pleural effussion and serum level of CRP in 60 cases of malignant pleural effussion,46 cases of tuberculous pleural effusion and 35 cases of parapneumonic pleural effussion were detected and compared.The relationship between pleural effussion and serum level of CRP and the relationship between CRP level and carcinoembryonic antigen(CEA) level both in pleural effussion and serum were analyzed.The sensitivity and specificity of pleural effussion and serum level of CRP in diagnosis for malignant pleural effussion were also detected.Results Both pleural effussion and serum level of CRP in patients with malignant pleural effussion were lower than the ones with tuberculous pleural effusion and parapneumonic pleural effussion.There were positive correlation between pleural effussion and serum level of CRP(r = 0.537,P < 0.001) and negative correlation between CRP level and CEA level both in pleural effusion(r =-0.511,P < 0.001) and serum(r =-0.332,P < 0.001).The sensitivity of pleural effussion level of CRP < 20 mg/L and serum level of CRP < 10 mg/L in diagnosis for malignant pleural effussion were 68.3% and 93.3% respectively and the specificity of which were 93.8% and 92.6% respectively.The sensitivity and specificity of pleural effussion level of CRP < 20 mg/L combined with serum level of CRP < 10 mg/L in diagnosis for malignant pleural effussion were 61.7% and 97.5% respectively.Conclusion Combined detection of effussion and serum level of CRP plays an important role in differential diagnosis for malignant pleural effussion.