肿瘤标志物联合检测在胸腹水性质鉴别中的临床应用

目的：探讨CEA、CA125、CYFRA21-1等8种肿瘤标志物检测在胸腹水鉴别诊断中的临床应用价值.方法：采用电化学发光法分别对176例患者的胸水和/或腹水进行癌胚抗原（CEA）、糖类癌抗原125 （CA125）、细胞角蛋白片段19（CYFRA21-1）等8项肿瘤标志物检测（其中恶性胸腹水81例,结核性胸腹水45例及不明原因胸腹水50例）,评价上述指标在鉴别胸腹水性质诊断中的灵敏度及特异性.结果：8项肿瘤标志物在良、恶性胸腹水中的表达水平具有显著性差异（P＜0.05）.恶性胸腹水中CEA、CA125、CYFRA21-1、NSE的水平及阳性率较高,分别为94%、81%、62%和52%.相关胸腹水肿瘤标志物联合检测对鉴别诊断不同良恶性胸腹水有统计学意义（P＜0.05）.结论：胸腹水中CEA、CA125、CYFRA21-1、NSE联合检测对良恶性胸腹水鉴别诊断有重要价值.     

血清和胸水中肿瘤标志物对肺癌恶性胸水诊断意义的比较

目的:探讨恶性胸腔积液患者血清和胸水中癌胚抗原（CEA）、癌抗原-125（CA-125）、铁蛋白（Ferritin）及神经元特异性烯醇化酶（NSE）对恶性胸腔积液诊断的临床意义。方法:恶性胸水的肺癌患者共37例,测量其血清和胸水中的CEA、CA-125、铁蛋白、NSE含量,并进行比较。结果:肺癌患者胸水中CEA、CA-125、铁蛋白含量均明显高于血清组（均P<0．05）,而胸水和血清中NSE比较差异无统计学意义（P>0．05）。结论:肺癌患者胸水中肿瘤标志物的阳性率要高于血清中。联合检测胸水中肿瘤标志物对于肺癌的诊断意义更大。     

六种肿瘤标志物在肺癌胸腔积液中的诊断价值

目的通过对胸腔积液和血清中6种肿瘤标志物的检测及胸腔积液脱落细胞学检查,探讨各指标在肺癌胸腔积液中的诊断价值。方法应用化学发光法和酶联免疫分析法测定50例肺癌和30例肺良性疾病患者的胸腔积液和血清中的癌胚抗原（CEA）、糖类抗原19—9（CA19—9）、鳞状细胞癌抗原（SCC）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）、胃泌素前体释放肽（ProGRP）水平,同时对胸腔积液标本进行脱落细胞学检查,并根据受试者工作特性曲线（ROC）建立合理的临床判断临界值。结果肺癌患者胸腔积液中6种肿瘤标志物水平均高于肺良性疾病者,其中CEA、CA19-9、CYFRA21—1、ProGRP水平显著高于肺良性疾病组（P〈0．05）。胸腔积液CEA、血清CYFRA21—1及CEA含量在胸腔积液与血清中的比值（P／S）在各组中的ROC曲线下面积最大。结论胸腔积液CEA、血清CYFRA21—1及CEA的P／S值在鉴别良、恶性胸腔积液中有一定的辅助诊断价值,胸腔积液CEA的诊断价值最大。     

肿瘤标志物检测对癌性和结核性胸腔积液的鉴别诊断价值

目的探讨肿瘤标志物检测对癌性、结核性胸腔积液鉴别诊断的临床价值。方法收集2013年5月至2014年4月间收治的110例胸腔积液患者的临床资料,其中癌性组52例,结核性组58例,对两组患者的癌胚抗原(CEA)、糖类抗原(CA199、CA153)测定结果进行比较。结果癌性组患者血清及胸腔积液中CEA、CA199、CA153水平明显高于结核性组患者,差异均有统计学意义(P<0.05)。联合检测CEA、CA199、CA153对恶性胸腔积液的敏感度均明显高于单独检测CEA和糖类抗原CA199、CA153,差异有统计学意义(P<0.05)。结论肿瘤标志物CEA、CA199、CA153对癌性、结核性胸腔积液具有鉴别诊断价值,且两者联合检测能够明显提高癌性胸腔积液的诊断敏感度。     

联合检测肿瘤标志物在胸腔积液中的应用价值

目的:探讨胸腔积液中肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片断(CYFRA21-1)、神经元特异性烯醇化酶(NSE)检测在胸腔积液诊断中的价值。方法:应用电化学发光法对65例肺癌患者和28例良性对照者的血清和胸腔积液进行检测。结果:肺癌组中血清和胸水肿瘤标志物明显高于对照组(P<0.01);肺癌组胸水三项指标高于血清水平(P<0.01);CEA对肺腺癌,NSE对小细胞肺癌,CYFRA21-1对肺鳞癌的阳性率高于其它单项(P<0.05)。结论:胸腔积液CEA、NSE、CYFRA21-1检测有助于肺癌的诊断。     

Clinical evaluation of four tumor markers in malignant and benign pleural effusions.

Total sialic acid (TSA), lipid-bound sialic acid (LSA), ferritin and carcinoembryonic antigen (CEA) were evaluated in 55 patients with malignant pleural effusions and in 32 patients with benign (exudative) pleural effusions. No significant differences were found in the pleural fluid TSA, LSA and ferritin levels between malignant and benign conditions. CEA levels in malignant effusions were significantly higher than those in benign effusions (43.13 +/- 72.8 ng/ml versus 2.6 +/- 5.56 ng/ml, p less than 0.01). At a cut-off level of 5 ng/ml, 60% of the patients with cancer showed elevated pleural fluid CEA levels. The specificity and diagnostic accuracy of CEA in distinguishing malignant from benign pleural exudates were both very high (91% and 71% respectively). Therefore, of the four markers investigated, only CEA could be a valuable tool in the detection of pleural malignancy.     

DNA倍体联合肿瘤标志物在恶性胸腔积液初筛中的临床价值

目的:探讨DNA倍体联合肿瘤标志物检验恶性胸腔积液的临床价值.方法:70例胸腔积液患者,分为恶性组、良性组.采用全自动细胞分析仪对胸腔积液进行DNA倍体分析,并同时检测NSE、CYFRA21-1、CEA、CA199、SF.结果:恶性胸腔积液中DNA倍体和各肿瘤标志物(NSE、CYFRA21-1、CEA、CA199、SF)的灵敏度分别为80.00%、45.83%、76.67%、60.00%、26.67%、72.00%,特异性分别为82.50%、88.24%、70.97%、95.00%、100.00%、55.17%,准确性分别为82.43%、70.68%、73.77%、80.00%、68.11%、63.64%.组合模型中以DNA倍体串联CEA,DNA倍体并联铁蛋白诊断价值较高.结论:使用DNA细胞全自动检测分析仪对恶性胸腔积液进行DNA倍体测量具有很高的阳性率、灵敏度,如果联合胸腔积液肿瘤标志物中的CEA或SF可提高其临床诊断价值.     

Tumor markers in pleural effusion diagnosis

In order to discriminate between malignant and benign effusions, the values of carcinoembryonic antigen (CEA), ferritin, beta2-microglobulin (BMG), acid-soluble glycoprotein (ASP), tissue polypeptide antigen (TPA), adenosine deaminase (ADA), and immunosuppressive acidic protein (IAP) were measured in the pleural fluid of 54 patients with lung cancer, 20 with malignancies other than lung cancer, 18 with tuberculous pleurisy, and 22 with benign diseases other than tuberculosis. CEA levels in malignant effusions were significantly higher than those in benign effusions. At a cutoff level of 5 ng/ml, 68% of the patients with lung cancer and 44% of the patients with other malignancies showed elevated pleural fluid CEA levels. In 13 lung cancer cases with negative pleural fluid cytology, nine cases had elevated pleural fluid CEA levels. The mean pleural fluid BMG level of patients with benign diseases was significantly higher than that of patients with malignant diseases, but there was a marked overlap between those with malignant and benign diseases. No significant differences were found in the pleural fluid ferritin, ASP, TPA, and IAP levels between malignant and benign conditions. ASP and IAP pleural fluid levels showed significant correlations with the pleural fluid C-reactive protein (CRP) concentrations suggesting that they also reflect inflammatory activity. The mean ADA activity in tuberculous effusion was significantly higher than that resulting from other causes of pleural effusion.     

DNA倍体联合肿瘤标志物检测在胸腔积液诊断中的应用

目的探讨DNA倍体分析联合肿瘤标志物在良、恶性胸腔积液诊断中的价值。方法将108例胸腔积液分为恶性组（68例）和良性组（40例）。除常规细胞学检查外,以流式细胞术（flowcytometry,FCM）检测患者胸腔积液中的DNA倍体,采用化学发光法测定胸腔积液中CEA、CA199、NSE、CYFRA211、SCC、CA125等肿瘤标志物含量。比较DNA倍体联合肿瘤标志物诊断与细胞学诊断的优劣。结果DNA倍体诊断恶性胸腔积液的敏感性、特异性分别为70．6％、95．0％,Youden’s指数为0．656,敏感度稍高于细胞学诊断的65．1％,差异无统计学意义（P〉0．05）。除NSE外,其他5种肿瘤标志物在恶性胸腔积液中浓度均高于良性,差异有统计学意义（P〈0．05）。CYFRA211、CEA、CAl99、CAl25、SCC、NSE的AUC分别为：0．893,0．828,0．759,0．691,0．524及0．490;COV分别为：149．2ng／mL,53．6ng／mL,78．2IU／mL,1559．0IU／mL,48．72ng／mL及78．3ng／mL;敏感性分别为：44．1％,44．1％,35．3％,29．4％,13．2％,5．9％,特异性均为100％。4种肿瘤标志物联合检测＋DNA倍体检测的敏感性为88．2％（60／68）,特异性95％,显著高于细胞学诊断。结论DNA倍体联合CEA、CA199、CYFRA211和CA125检测诊断恶性胸腔积液有较高敏感性,具有定量、快速、价廉、易标准化的特点,且操作简单。     

恶性胸腔积液肿瘤标志物

许多方法和指标都曾尝试用于恶性胸腔积液的诊断,各有利弊。随着分子生物学和实验技术的迅速发展,新的诊断指标和检测方法不断涌现。现根据近年来相关的临床研究结果,对各种肿瘤标志物进行客观评价。     

恶性胸腔积液肿瘤标志物

许多方法和指标都曾尝试用于恶性胸腔积液的诊断,各有利弊。随着分子生物学和实验技术的迅速发展,新的诊断指标和检测方法不断涌现。现根据近年来相关的临床研究结果,对各种肿瘤标志物进行客观评价。     

Clinical significance of serum basic fetoprotein and various tumor markers in primary lung cancer

Background To investigate the clinical significance of basic fetoprotein in lung cancer, serum basic fetoprotein was measured in 81 patients with primary lung cancer and 40 patients with other nonmalignant pulmonary diseases. Methods For comparison, various tumor markers such as carcinoembryonic antigen, sialyl Lewis^x-1 (SLX), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), tissue polypeptide antigen, squamous cell carcinoma related antigen (SCC), and neuron specific enolase were also measured. Results Fifty-nine percent of the patients with primary lung cancer had a positive basic fetoprotein level. This rate was higher than that for carcinoembryonic antigen and tissue polypeptide antigen, but lower than that for SLX. Histologic classification showed that basic fetoprotein occurred more frequently in small cell and large cell carcinomas. Carcinoembryonic antigen and SLX showed high specificity in adenocarcinoma, and SCC and neuron specific enolase showed high specificity in squamous cell and small cell carcinoma, respectively. Basic fetoprotein levels tended to be higher in the advanced stages of disease, and the change of basic fetoprotein levels was related to chemotherapeutic response. However, this tendency was not observed in patients who did not respond to chemotherapy; this was particularly pronounced in those with small cell carcinoma. In the study of various tumor markers, a correlation was observed only between basic fetoprotein and neuron specific enolase, which suggests that these 2 tumor markers are valuable in a combination assay. Conclusion The measurement of basic fetoprotein is a useful method for monitoring the effectiveness of treatment in primary lung cancer.     

血清及胸腔积液中四种肿瘤标志物联合应用对良恶性肿瘤鉴别诊断价值的评估

目的探讨肿瘤标志物CEA、CA125、CA15-3及CA19-9联合应用对鉴别良性胸腔积液(BPE)和恶性胸腔积液(MPE)的价值。方法收集327例2013-01-01-2015-06-30在首都医科大学附属北京朝阳医院(174例)和华中科技大学同济医学院附属协和医院呼吸与危重症医学科(153例)住院的胸腔积液(PE)患者,其中MPE患者119例,BPE患者208例。取PE标本及配对血清标本,应用化学发光法检测CEA、CA125、CA15-3及CA19-9在血清及PE中的浓度,应用二元Logistic回归模型和L1正则化(LASSO)方法将患者基本信息与PE、血清中4种肿瘤标志物CEA、CA125、CA15-3及CA19-9进行不同方式的联合,通过受试者工作特征(ROC)曲线分析和比较不同联合诊断模型的诊断价值。结果PE中CEA+CA15-3+CA19-9的联合模型对应ROC曲线下面积(AUC)值最大(0.90),血清中此联合模型对应的AUC值也是最佳(0.863),PE中的联合模型优于血清中的联合诊断模型,P=0.0125,综合预测能力最强。PE与血清肿瘤标志物浓度差值中CEA+CA15-3+CA19-9的联合模型对应的灵敏度最佳(80.2%),特异度为79.1%。基于LASSO变量选择方法的联合模型在PE中的特异度最佳(96%),此时灵敏度为73%,阳性似然比22。以上结果均P<0.001。PE中CEA+CA15-3+CA19-9的联合模型对应的AUC值(0.90)优于PE中CEA对应的AUC值(0.824),P<0.001。结论联合应用CEA、CA15-3及CA19-9在诊断效能、灵敏度、特异度、阳性似然比等方面优于其他组合,且优于PE中的CEA对BPE/MPE的鉴别诊断价值。     

胸腔积液与血清癌胚抗原比值对胸腔积液性质的诊断效果

目的 探讨胸腔积液与血清癌胚抗原比值对胸腔积液性质的诊断效果.方法 选取2018年1月至2019年10月间上海市宝山区罗店医院收治的86例胸腔积液患者,按照胸腔积液良恶性质将患者分为恶性组34例和良性组52例.使用电化学发光免疫分析法检测患者的胸腔积液、血清癌胚抗原水平,计算两者比值,比较两组患者及恶性组不同病理类型的...     

Clinical evaluation of HER-2/neu protein in malignant pleural effusion-associated lung adenocarcinoma and as a tumor marker in pleural effusion diagnosis.

PURPOSE: Lung adenocarcinoma presenting as malignant pleural effusion (MPE) is common in Taiwan. Microscopically, the involved pleurae are infiltrated by numerous tumor foci, which suggests that the cancer cells are highly invasive. Overexpression of HER-2/neu has been related to proliferation, antiapoptosis, and the high invasiveness of various cancer cells. We therefore were interested in studying the role of HER-2/neu in MPE-associated adenocarcinoma cell lung cancer (ADCLC). Experimental Design: The expression of HER-2/neu in pleural effusion was measured by ELISA. The HER-2/neu protein expression on tumor cells was evaluated by immunohistochemical (IHC) staining, and gene amplification was assayed by fluorescence in situ hybridization. RESULTS: The mean value of HER-2/neu in pleural effusions of patients with ADCLC and other nonmalignant lung diseases was 9.9 and 2.7 ng/ml, respectively. The difference is statistically significant (P < 0.001). Compared with cytokeratin 19 fragment CYFRA 21-1, the performance of HER-2/neu as a tumor marker in pleural effusion diagnosis was better. Overexpression of HER-2/neu in tumor tissues was found in 70% (23 of 32) of patients with MPE-associated ADCLC, 30% (13 of 43) with stage I/II non-small cell lung cancer (NSCLC), and 44% (14 of 32) with stage III NSCLC. The incidence of HER-2/neu overexpression in tumor tissues of patients with MPE-associated ADCLC was significantly higher than that of patients with stage I-III NSCLC without MPE. HER-2/neu gene amplification was uncommon (1.9%). The correlation between the IHC H-score in tumor samples and the pleural effusion level of HER-2/neu was significant (P < 0.01). A higher incidence of HER-2/neu expression beyond the cutoff point (5.5 ng/ml) in pleural effusions was also found in patients whose IHC H-scores were >50. CONCLUSIONS: These findings indicate that HER-2/neu is important in the pathogenesis of MPE-associated ADCLC and is a potential tumor marker for a diagnosis of pleural effusion.     

良恶性胸腔积液的临床特征及预测因素分析

目的:对比分析良恶性胸腔积液的临床特征,筛选恶性胸腔积液可能的预测因素。方法:收集良性胸腔积液患者30人和恶性胸腔积液患者32人的临床资料,分析胸腔积液及血液学相关指标（胸腔积液物理性状、胸腔积液和血液学生化、肿瘤标志物）。结果:恶性胸腔积液患者的年龄明显高于良性胸腔积液患者,但二者在性别分布上无差异。恶性胸腔积液的乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、γ-干扰素（γ-IFN）显著低于良性胸腔积液,而癌胚抗原（CEA）、糖类抗原（CA19-9）、神经特异性烯醇化酶（NSE）显著高于良性胸腔积液（P均<0.05）。两组患者血液LDH、ADA、CEA、CA19-9的差异也具有统计学意义。条件Logistic回归分析发现CEA>10ng/ml、血性胸腔积液、ADA<15U/ml、CA19-9>20U/ml为恶性胸腔积液的预测因素。结论:非肿瘤标志物（如胸水颜色、ADA值）也有助于胸腔积液性质的判断。恶性胸腔积液的预测作用由大到小依次为CEA、血性胸腔积液、ADA、CA19-9。     

CEA and CA 549 in serum and pleural fluid of patients with pleural effusion

BACKGROUND: The determination of the pleural fluid (PF) carcinoembryonic antigen (CEA) concentration has proved helpful in the differentiation between pleural effusions (PE) of malignant and benign origin. The present study was designed to prospectively compare the utility of CEA with that of a recently introduced tumour marker, carbohydrate antigen 549 (CA 549). PATIENTS AND METHODS: In 383 consecutive patients referred for thoracentesis (130 malignant and 253 benign), pleural and serum levels of CEA and CA 549 were, respectively, determined by enzyme immunoassay (EIA) and immunoradiometric assay (IRMA). RESULTS: CEA and CA 549 showed a high specificity for malignancy in serum (97 and 96%, respectively) and PF (98 and 99%). The serum sensitivity was 33% for CEA and 47% for CA 549 while in PF was 49 and 54%, respectively. The area under the curve of CA 549 (0.78) was significantly larger than that of CEA (0.66) in serum (P < 0.005) and in PF (0.83 and 0.75, respectively, P < 0.02) as well. CA 549 showed a higher sensitivity (P < 0.001) than CEA for ovarian tumours. In PF, the accuracy of the combination of both markers was higher than that of any individual marker, although the difference was only significant with respect to CEA (P < 0.02). CONCLUSIONS: The results of the present study show that a new tumour marker CA 549 is at least similar in terms of sensitivity and specificity to CEA in the evaluation of patients with PE of unknown cause.     

Clinical evaluation of tumor markers in breast cancer patients

During the past 4 years, the performances of various tumor markers such as CA15-3, CEA, ferritin, beta 2-microglobulin and TPA have been evaluated in 78 cases of mammary cancer. The results were categorised according to differences in stages, difference in values from patients with recurrent tumors, the incidence of abnormal values and differences in values before and after surgery. When the incidence of values higher than the cutoff value was determined for each of stage I, II and III + IV, the rates for CEA were 14.3%, 4.9% and 27.8%, respectively, whereas those for TPA were 25.0%, 22.2% and 26.7%, respectively. In addition, for CA15-3, the incidences were 0% in stage I, 5.0% in stage II and 57.1% for combined stages III + IV. The average values for patients with recurrent tumors were 3.2 ng/ml CEA, 194.5 ng/ml ferritin, 316.2 U/l TPA and 81.3 U/ml CA15-3. The rates of abnormal values were 40.0% for CEA, 40.0% for ferritin, 85.7% for TPA and 63.6% for CA15-3. Differences in the values after surgical removal of the tumor were observed with these tumor markers: the CEA value was reduced from 1.6 +/- 1.4 to 1.1 +/- 0.5 (p less than 0.01) and the CA15-3 value from 12.2 +/- 8.4 to 9.3 +/- 4.1 (p less than 0.05), respectively, whereas that for ferritin was conversely increased from 48.9 +/- 48.0 to 74.0 +/- 70.0 (p less than 0.01). However, the values for TPA, despite showing a tendency to decrease, did not show any statistically significant alteration. The fluctuations of these marker levels in patients with recurrent tumors reflects the progress of the disease, with a sudden elevation in values indicating imminent death. The diagnostic significance of these markers is not high, but they are considered to be useful in detecting the progress or condition of a recurrent tumor.