心钠素、癌胚抗原及铁蛋白联合检测鉴别良、恶性胸腔积液

１引言良性胸腔积液和恶性胸腔积液的鉴别诊断有时相当困难，作为诊断恶性胸腔积液特异性最强的指标细胞学检查，其敏感性也仅为５０％，阴性者也不能完全排除肿瘤之诊断。因此，探讨一种新的可靠的辅助检测方法，为临床诊断提供依据是十分必要的。近年来通过检测胸腔积液中的肿瘤标志物，可有助于良、恶性胸腔积液的鉴别诊断。目前可供检测的肿瘤标志物种类繁多，包括肿瘤相关抗原（如癌胚抗原、糖链抗原：CA７２－４、CA５０、CA１９－９、CA１２５）、肿瘤相关蛋白（如铁蛋白）、激素（如心钠素）、酶与同工酶、癌基因及抗癌基因等；…     

胸水与血清中癌胚抗原对良恶性胸腔积液诊断的价值

目的 :探讨胸腔积液患者胸水与血清的癌胚抗原 (CEA)水平及其比值对良恶性胸腔积液 (以下简称胸液 )的诊断价值。方法 :采用放射免疫分析法 (RIA)分析 48例胸腔积液患者胸水与血清的癌胚抗原水平及其比值。结果 :恶性胸液患者胸水与血清中的CEA(ug L)水平明显高于良性胸液患者 ,恶性胸液患者胸水 血清CEA比值超过 1 5 ,恶性胸液组血清和胸水CEA水平与良性胸液组差异有显著性 (P <0 0 5 )。结论 :检测患者胸水与血清CEA水平及其比值有助于临床胸水性质的诊断。     

染色体检测对恶性胸水的诊断价值

目的 探讨染色体检测对恶性胸水的诊断价值.方法 采用常规染色体定性检查和流式细胞术DNA定量分析检查胸腔积液中的染色体,并进行比较.结果 常规染色体检查对恶性胸腔积液诊断的特异性为90.9%,敏感性为88.9%;FCM法特异性为98.9%,敏感性为90.9%;二者联合的特异性为98.6%,敏感性为88.4%.结论 常规染色体检查和流式细胞术(FCM)DNA定量分析方法联合检查对胸腔积液的诊断提供了可靠的诊断依据.     

胸腔积液及腹水染色体检测对良恶性胸腔积液及腹水的辅助诊断

目的探讨胸腔积液及腹水染色体检测在鉴别良、恶性胸腔积液及腹水中的作用,以便用于辅助临床良、恶性胸腔积液及腹水的诊断与鉴别诊断。方法对90例胸腔积液及腹水,包括良、恶性胸腔积液及腹水应用细胞遗传学短期培养法,G显带、染色体直接制片法,以中期分裂象细胞超二倍体和多倍体大于或等于10%为恶性积液,腺苷脱氨酶(ADA)<25U/L为恶性胸腔积液及腹水诊断标准,乳酸脱氢酶(LDH)>300U/L为阳性标准,癌胚抗原(CEA)>15μg/L为恶性胸腔积液及腹水诊断标准。结果胸、腹水染色体短期培养法成功率为81.1%,在恶性胸腔积液及腹水中出现多倍体的特异性为100.0%;ADA在非恶性胸腔积液及腹水的敏感性为22.9%,在恶性胸腔积液及腹水中的敏感性为100.0%,但无特异性;LDH在恶性胸腔积液及腹水中的阳性率为90.1%,在非恶性胸腔积液及腹水的敏感性为32.6%;CEA在恶性胸腔积液及腹水中的阳性率为63.6%。结论采用胸腔积液及腹水细胞遗传学短期培养方法,与染色体直接制片法检测,有利于提高良、恶性胸腔积液及腹水的诊断和鉴别诊断。     

B7-H3和癌胚抗原在恶性胸腔积液中的检测及临床意义

目的探讨B7-H3和癌胚抗原(CEA)在恶性胸腔积液(MPE)诊断中的价值。方法收集40例MPE和22例良性胸腔积液(BPE)标本,应用酶联免疫吸附试验(ELISA)法测定B7-H3和CEA在MPE和BPE中的表达,绘制受试者工作曲线(ROC曲线),计算相应曲线下面积(AUC)、确定诊断MPE灵敏度、特异度及诊断界值。结果 B7-H3诊断MPE的相应灵敏度、特异度为62.5%、81.0%,AUC为0.777;CEA诊断MPE的相应灵敏度、特异度为72.5%、81.0%,AUC为0.850;二者联合诊断的灵敏度、特异度为70.0%、98.2%,AUC为0.910。结论 B7-H3和CEA可作为MPE的诊断指标,二者联合应用诊断价值更高,有望在未来临床中诊断中应用。     

胸腔积液癌胚抗原和细胞学检测的关系及临床意义

发现瘤细胞是诊断恶性胸腔积液的金标准,而癌胚抗原（carcinoembryonic antigen,CEA）是目前应用较广泛的胸液肿瘤标志物,但临床上两者的检测结果有时并不完全一致。纵观近些年的资料,两者的研究大都集中在各自的领域中,对它们之间的关系及如何使两种方法相得益彰,给临床提供更多信息的研究较少。近年我们对胸腔积液CEA和细胞学检测的关系进行了总结,现报道如下。     

探讨渗出性胸腔积液ADA、CEA对良恶性胸腔积液的诊断价值

目的 探究渗出性胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)对良恶性胸腔积液的诊断价值.方法 选择2017年1月至2020年8月本院收治的106例渗出性胸腔积液患者,将患者分为恶性组(n=36)和良性组(n=70).对两组患者胸水ADA、胸水CEA、血清CEA水平进行比较,采用单因素、多因素Logistic回归分析...     

染色体检查在恶性胸腔积液诊断中的价值

目的探讨染色体检查在胸腔积液鉴别诊断中的价值。方法采用常规染色体定性检查和流式细胞术(FCM)DNA定量分析两种方法检查胸腔积液中的染色体,并进行比较。结果常规染色体检查对恶性胸腔积液诊断的特异性为98．2％,敏感性为88．9％;FCM法特异性为100％,敏感性为93．8％;二者联合的特异性为100％,敏感性为86．4％。结论常规染色体检查和FCM DNA定量分析两种方法联合检查对胸腔积液的鉴别诊断提供了可靠的诊断依据。     

电子支气管镜及胸水癌胚抗原和CA125检查对不明原因胸腔积液的诊断价值

目的 探讨电子支气管镜、胸水癌胚抗原(CEA)、糖类抗原(CA125)检查对不明原因胸腔积液的诊断价值.方法 2007年2月至2008年6月住院的不明原因的胸腔积液患者45例,行电子支气管镜及胸水CEA、CA125检查.结果 恶性胸腔积液CEA、CA125呈高活性,电子支气管镜检查对不明原因胸腔积液诊断有较高价值.结论 电子支气管镜结合胸水CEA、CA125检查可作为一种诊断不明原因胸腔积液的有效手段.     

染色体检查和胸膜活检联合运用对恶性胸腔积液的诊断价值

目的 探讨胸水染色体检查、胸膜活检及其联合运用对恶性胸腔积液的诊断价值。方法 通过对43例恶性胸腔积液患者分别行胸水染色体、胸膜活检检查,观察并比较它们的阳性率。结果 单独行胸水染色体检查,阳性率41．9％;单独膜膜活检,阳性率67．4％。而者均有显著统计学意义（P＜0．05）。两种方法联用阳性率为88．4％,与单独一种方法比较,有显著性差异（P＜0．05）。结论 两项检查均较安全,对良、恶性胸腔积液鉴别诊断有显著意义,联合运用能大大提供确诊率。     

脂联素、血管内皮生长因子及癌胚抗原对癌性胸腔积液的诊断价值

目的:探讨脂联素(adiponectin)、血管内皮生长因子(vascular endothelial growth factor,VEGF)和癌胚抗原(carcinoembryonic antigen,CEA)在癌性胸腔积液患者中的临床诊断价值。方法:取癌性组患者36例、良性组患者42例,用双抗体夹心酶联免疫吸附实验(ELISA)法检测胸腔积液中脂联素以及VEGF水平,CEA的含量用放射免疫法(RIA)测定。结果:胸腔积液脂联素、VEGF及CEA作为诊断指标的敏感性分别是76.2%、69.4%、64.7%,特异性分别是77.8%、71.4%、88.1%;联合诊断中以脂联素联合CEA的诊断功效最高,其敏感性、特异性分别是49.3%、97.4%。结论:脂联素、VEGF和CEA可作为癌性胸腔积液的鉴别诊断指标,在胸腔积液中联合脂联素及CEA的诊断功效最高。     

Diagnostic utility of pleural fluid carcinoembryonic antigen and CYFRA 21-1 in patients with pleural effusion: a systematic review and meta-analysis

Pleural effusions (PE) are the most common complications that may be produced by a wide variety of diseases. A large number of studies exploring the role of carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) marker in differential diagnosis of PE have been published, employing differing methodologies with sometimes conflicting results. A comprehensive systematic review would be useful to synthesize the currently available bulk of information. The objective of this work was to assess and compare the overall value of pleural fluid CEA and CYFRA 21-1 in differential diagnosis of PEs with a meta-analysis. All the English and Chinese published studies for differential diagnosis of PEs by pleural fluid CEA and CYFRA 21-1 were collected. Methodological quality of the included studies was evaluated. Pooled sensitivity and specificity were calculated, the threshold effect and the possible sources of heterogeneity were also analyzed. Summary receiver operating characteristic (SROC) curve analysis was used to compare the differential diagnostic ability of pleural fluid CEA and CYFRA 21-1. A total of 19 studies were included in the meta-analysis, with a total of 3,228 subjects. Pooled sensitivity and specificity of CEA and CYFRA 21-1 were 45.9% (43.2-48.5%) and 97.0% (96.0-97.8%), and 47.3% (44.0-50.6%) and 91.8% (89.5-93.7%), respectively. Both CEA and CYFRA 21-1 have a threshold effect, the main source of heterogeneity was from variable assay methods. The areas under the SROC curve (AUCs) of CEA and CYFRA 21-1 were 0.7691 and 0.8213, respectively. There was no statistical significance between the AUC of CEA and CYFRA 21-1 (P>0.05). Both CEA and CYFRA 21-1 have good performance in the differential diagnosis of PE, when compared with CEA, CYFRA 21-1 has no advantage.     

良、恶性胸水表达癌胚抗原信使核糖核酸--癌胚抗原系统差别的研究

目的分析癌胚抗原信使核糖核酸(CEAmRNA)-癌胚抗原(CEA)系统在良、恶性胸水中表达的差别,探讨应用CEAmRNA和CEA指标诊断恶性胸水的价值.方法采集胸水为检测标本,其中恶性胸水92例、良性胸水54例.应用反转录-套式-聚合酶链反应(RT-NP-PCR)检测CEAmRNA,应用磁性抗体分离酶联免疫测定(MAIA)检测CEA.结果不同胸水表达CEAmRNA和CEA的阳性结果分别为良性5.6%(3/54)和7.4%(4/54)、恶性80.4%(74/92)和54.3%(50/92),两者差别具有统计学意义(P＜0.001).指标诊断恶性胸水的特异性和敏感性分别为CEAmRNA 94.4%和80.4%,CEA分别为92.6%和54.3%,CEAmRNA的敏感性明显高于CEA(P＜0.01).结论CEAmRNA-CEA系统在良、恶性胸水中的表达的差别具有统计学意义,可以用作诊断与鉴别诊断恶性胸水的指标.其中,CEAmRNA在恶性胸水中的表达率和敏感性比CEA更高,有望成为一个新的、有实用价值的肿瘤标志物.     

Tension hydrothorax and shock in a patient with a malignant pleural effusion

A patient presented to the emergency department with a malignant pleural effusion associated with shortness of breath, and radiographic evidence of mediastinal shift and hypotension. Tube thoracostomy yielded serosanguinous pleural fluid under pressure and after 1 liter of fluid was drained, the patient's hemodynamic status stabilized. The entity of tension hydrothorax is rare but may be life threatening. The treatment should consist of prompt drainage and efforts to prevent recurrence. As physicians become more adept at prolonging the lives of patients with cancer, tension hydrothorax may become more common.     

Elevation of carcinoembryonic antigen in cerebrospinal fluid among patients with meningeal carcinomatosis

The concentration of carcinoembryonic antigen (CEA) in cerebrospinal fluid (CSF) was determined by using an enzyme immunoassay for 204 patients with various nonneoplastic neurologic disorders, 8 patients with systemic infectious diseases, 19 patients with systemic neoplastic diseases without involvement of the nervous system, and 35 patients with neoplastic neurologic disorders. The highest CEA level in CSF among patients without neoplastic neurologic disorders was 0.6 ng/ml. Of 35 patients with neoplastic neurologic disorders, 10 had CEA levels in CSF that exceeded 0.6 ng/ml, the highest level being 70.5 ng/ml. All 10 patients had carcinomas. Among 14 patients with neoplastic meningitis, 5 of 8 patients with meningeal carcinomatosis had elevated CEA concentrations. Although the efficacy of the assay for CEA in CSF must be compared with that of other laboratory tests such as cytologic examination and the assay for beta-glucuronidase--and any potentially false-positive results should be ruled out by determination of the serum CEA level--the CEA concentration in CSF can be used as an adjunctive diagnostic procedure for detection of meningeal carcinomatosis.     

应用中心静脉导管引流恶性胸腹水的观察与护理

探讨应用中心静脉导管行胸腔或腹腔置管引流恶性胸腹水并灌注化疗药物的护理措施。对56例行导管引流的晚期恶性肿瘤患者,加强置管前宣教、置管中配合、置管后护理及并发症的预防,减少了胸腔、腹腔的穿刺次数,减轻肿瘤患者的痛苦,提高患者的生活质量。     

Pleural fluid findings as prognostic factors for malignant pleural mesothelioma

The aim of this study was to determine the prognostic value of pleural fluid glucose, lactate dehydrogenase (LDH), albumin, total protein, and total leukocyte levels in patients with malignant pleural mesothelioma. We retrospectively analyzed 71 consecutive patients (33 men and 38 women) who were referred to the department of chest diseases in a university hospital. Pleural fluid glucose levels, the ratio of pleural fluid to serum LDH>1.0, and total leukocyte count were significant predictors for the survival in univariate analysis. However, none of these variables emerged as statistically significant from the multivariate Cox model. In conclusion, our results showed that there is an inverse correlation between the intensity of inflammation and survival.     

Diagnostic performance of CTLA-4, carcinoembryonic antigen and CYFRA 21-1 for malignant pleural effusion

Objectives: The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. The present study aims to investigate whether CTLA-4 levels may correlate with presence of MPE and to assess its potential diagnostic accuracy relative to that of the established markers carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21–1).

Methods: Pleural effusion samples were collected from 36 patients with MPE and 48 patients with benign pleural effusion (BPE). Pleural levels of CTLA-4 were measured by ELISA; levels of CEA and CYFRA 21-1, by electrochemiluminescence immunoassay. Receiver operating characteristic curves were calculated to evaluate the ability of CTLA-4, CEA and CYFRA 21-1 to differentiate MPE from BPE.

Results: Pleural levels of CTLA-4 were significantly higher in MPE than in BPE patients (471.73 ± 378.86 vs. 289.22 ± 173.67 pg/ml, p = 0.004). At a cut-off value of 351.25 pg/ml, the sensitivity and specificity of CTLA-4 in diagnosing MPE were 58.30% and 83.30%, respectively, and the area under the curve was 0.72. Pleural levels of CEA and CYFRA 21-1 were also higher in MPE. Using the combination of CTLA-4, CEA and CYFRA 21-1 increased diagnostic sensitivity to 88.89% and the area under the curve to 0.92.

Conclusion: The results of this preliminary study suggest that increased levels of CTLA-4 correlate with MPE, and that CTLA-4 may have some diagnostic usefulness when used in combination with conventional tumor markers such as CEA and CYFRA 21-1. These results justify larger, more rigorous studies to validate our findings.     

Serial carcinoembryonic antigen (CEA) blood levels in patients with ulcerative colitis

Fifty-seven patients with ulcerative colitis were folloued 1-49 months (mean, 18 months) with serial CEA determinations during periods of remission, mild relapses, and severe relapses. Elevated CEA titers correlated with activity and possibly extent of disease: 12% of patients with proctitis, 47% of patients with left-sided colitis, and 60% of patients with transverse or universal colitis had elevated CEA titers during a flare. Moreover, 24% of patients with mild flares and 86% of patients with severe flares had elevated CEA titers. Ninety-two percent of patients with extensive disease and severe flares had elevated CEA titers. Elevated CEA titers were correlated with histologic findings in three patients. Inflammation of mucosa was demonstrated by colonoscopy and confirmed by biopsy in one patient with persistently elevated CEA titers during clinical remission. In two other patients with active disease whose CEA titers fell prior to colectomy, marked denudation of colonic mucosa was noted. In this study, a transiently elevated CEA titer indicated either clinically active ulcerative colitis or active inflammation of colonic mucosa.     

腺苷脱氨酶 癌胚抗原在胸腔积液鉴别诊断中的价值

目的探讨腺苷脱氨酶（ADA）、癌胚抗原（CEA）在癌性胸腔积液、结核性胸腔积液及非结核良性胸腔积液鉴别诊断中的应用价值。方法同时测定癌性胸腔积液、结核性胸腔积液及非结核良性胸腔积液中ADA、CEA,并对数据进行分析。结果 （1）结核性胸腔积液ADA为48.00（34.73～59.18）U/L,高于癌性胸腔积液[6.80（11.50～17.88）U/L]和非结核良性胸腔积液[9.45（5.32～17.23）U/L],差异有统计学意义（P〈0.01）,癌性胸腔积液和非结核良性胸腔积液ADA比较差异无统计学意义（P〉0.05）。癌性胸腔积液CEA为47.80（11.54～900.00）μg/L,高于结核性胸腔积液[0.93（0.37～1.88）μg/L]和非结核良性胸腔积液[0.97（0.68～1.66）μg/L],差异有统计学意义（P〈0.01）,结核性胸腔积液与非结核性良性胸腔积液CEA比较差异无统计学意义（P〉0.05）。（2）ADA诊断结核性胸腔积液ROC曲线下面积为0.943;CEA诊断癌性胸腔积液ROC曲线下面积为0.927。结论胸腔积液ADA、CEA指标的测定,对胸腔积液性质的鉴别有较高的价值,可为临床诊断和治疗提供重要信息。