胸水CA125、CA199、CEA、NSE、CYFRA21-1、CA72-4对原发性肺癌的诊断价值

目的探讨胸水中糖链抗原125（CA125）、糖链抗原199（CA199）、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）和糖链抗原72-4（CA72-4）在原发性肺癌并胸腔积液的诊断和鉴别诊断、病理分型中的价值。方法采用电化学免疫荧光发光法同时检测90例原发性肺癌并胸腔积液患者（恶性胸腔积液组）和64例良性胸腔积液患者（良性胸腔积液组）胸水中CA125、CA199、CEA、NSE、CYFRA21-1和CA72-4水平。结果恶性胸腔积液组各胸水肿瘤标志物水平均高于良性胸腔积液组（P〈0．05）,其中CEA、CYFRA21-1、NSE分别对腺癌、鳞癌、小细胞肺癌最敏感。联合检测以CEA＋NSE＋CYFRA21-1最优,可使敏感性达98．9％,阴性预测值至96．6％,准确性提高至76．0％。结论胸水肿瘤标志物在原发性肺癌的诊断中价值较高,其中CEA的诊断价值最大,联合检测诊断准确性优于单项检测。     

端粒酶与CYFRA21-1联合测定对肺癌所致恶性胸腔积液同良性胸腔积液鉴别的诊断意义

背景与目的 恶性胸腔积液中端粒酶和CYFRA21-1均可呈阳性表达,单个肿瘤标志物测定存在敏感性和特异性均较低的问题.本文旨在探讨端粒酶和CYFRA21-1联合测定对肺癌所致恶性胸腔积液同良性胸腔积液的鉴别诊断意义.方法 80例肺癌致恶性胸腔积液和50例良性胸腔积液患者,采用端粒重复序列扩增-酶联免疫吸附法检测胸腔积液端粒酶活性,用酶免疫分析法检测CYFRA21-1水平,对测定结果进行统计学处理.结果 恶性胸腔积液端粒酶和CYFRA21-1水平明显高于良性胸腔积液,差异有统计学意义(t=17.252和t=13.951,P＜0.001).端粒酶活性诊断的敏感性为71.3%,特异性为86.0%,准确性为76.9%.CYFRA21-1诊断的敏感性为60.0%,特异性为78.0%,准确性为66.9%.两者联合测定的敏感性为90.0%,特异性为76.0%,准确性为86.9%.联合测定的敏感性和准确性均高于单项测定(χ2=9.002和χ2=19.201,P＜0.01;χ2=4.389和χ2=14.647,P＜0.05).结论 端粒酶和CYFRA21-1联合测定可提高良恶性胸腔积液鉴别诊断的敏感性和准确性.     

胸水CEA、NSE、CYFRA21-1检测对恶性胸腔积液的诊断价值

目的:探讨癌胚抗原(CEA)、神经特异性烯醇化酶(NSE)、细胞角质蛋白19片断(CYFRA21-1)联合检测对恶性胸腔积液的诊断价值.方法:采用放射免疫法测定176例病人胸腔积液中上述指标的含量.结果:62例恶性胸腔积液(肺癌)组的测定值显著高于70例非恶性胸腔积液组的测定值(P＜0.01).CEA、NSE、CYFRA21-1在肺癌中的腺癌、小细胞癌、鳞癌的测定值最高,阳性率亦最高.两项联检NSCLC以CYFRA21-1、CEA阳性率较高,SCLC以NSE、CYFRA21-1阳性率较高.三项标志物联合检测诊断肺癌并恶性胸腔积液的敏感性显著高于单项检测和两项联检.结论:三者联检有助于恶性胸腔积液的诊断.在肺癌并恶性胸腔积液中,CEA对腺癌,NSE 对小细胞癌、CYFRA21-1对鳞癌有较高的敏感性.     

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.     

血清五种肿瘤标志物联合检测对肺癌诊断准确率的影响

目的分析血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、糖类抗原125(CA125)和糖类抗原242(CA242)联合检测对肺癌诊断准确率的影响。方法选取2015年6月至2016年12月间南通市肿瘤医院收治的102例肺癌患者作为研究组,选取同期医院经胸片或胸部CT诊断为肺良性疾病的102例患者作为对照组;对两组患者进行血清CEA、CYFRA21-1、NSE、CA125和CA242联合检测,比较两组患者五种血清肿瘤标志物指标变化。结果研究组患者血清CEA、CYFRA21-1、NSE、CA125和CA242水平均较对照组升高明显,差异均有统计学意义(均P<0.05)。研究组患者在疾病不同分期内血清CEA、CYFRA21-1、NSE、CA125和CA242水平变化显著(P<0.05)。联合检测血清CEA、CYFRA21-1、NSE、CA125和CA242标志物水平,灵敏度为94.2%,特异性为76.5%,准确率为69.4%;单一检测血清CEA、CYFRA21-1、NSE、CA125和CA242灵敏度分别为64.2%、68.3%、51.9%、54.7%和55.6%,特异性分别为87.5%、61.2%、81.2%、81.6%和79.6%,准确率分别为59.7%、41.6%、42.4%、42.1%和61.2%;联合检测灵敏度与准确率均高于单一检测,差异均有统计学意义(均P<0.05)。结论应用血清CEA、CYFRA21-1、NSE、CA125和CA242联合检测,可提升肺癌诊断准确率,有助于早诊断、早治疗。     

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.     

细胞角蛋白19片断与癌胚抗原联合检测对良恶性胸腔积液的诊断价值

目的：探讨角蛋白19片断(CYFRRA21．1)与癌胚抗原(CEA)的联合检测对良恶性胸腔积液的鉴别诊断价值。方法：采用放射免疫分析法对40例恶性胸腔积液组、32例良性胸腔积液组，分别测定其血清及胸液中CYFRA21．1和CEA浓度。结果：恶性胸腔积液组血清及胸液CYFRA21．1和CEA浓度均显著高于良性胸腔积液组。结论：联合检测CYFRA21-与CEA有利于良恶性胸液的鉴别诊断。     

胸水和血清CEA、CA125、CYFRA21-1、NSE和Pro-GRP联合检测对肺癌的诊断价值

目的:探讨联合检测肺癌胸水和血清中癌胚抗原(CEA)、癌抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)、神经原特异性烯醇化酶(NSE)和胃泌素释放肽前体(Pro-GRP)5 种肿瘤标志物水平在肺癌临床诊断中的应用价值,以期提高鉴别良恶性胸水的能力。方法:用电化学发光法检测93例肺癌患者和54例肺炎性疾病患者的血清及胸水标本CEA、CA125、CYFRA21-1、NSE和Pro-GRP水平。结果:癌性胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物平均水平与炎性胸水组比较,差别均有统计学意义(P<0.05);癌性胸水组中CEA、CYFRA21-1、CA125的含量远远高于炎性胸水组（20~600倍）(P<0.01)。肺癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物水平与肺癌血清组比较,差别均有统计学意义(P<0.05)。肺癌胸水组中CEA、CYFRA21-1、CA125的含量远远高于肺癌血清组（7~80倍）(P<0.01),相比与正常对照组更是有200倍以上的增高(P<0.01),因此胸水中CEA、CYFRA21-1、CA125百倍左右的升高提示恶性肿瘤的存在。将93例癌性胸水和血清分为腺癌、鳞癌和小细胞癌。腺癌、鳞癌和小细胞癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物含量明显高于炎性胸水组(P<0.01);腺癌胸水组中CEA含量明显高于鳞癌和小细胞癌(P<0.01);鳞癌胸水组中CYFRA21-1含量明显高于腺癌和小细胞癌(P<0.01);小细胞癌胸水组中NSE和Pro-GRP含量明显高于腺癌和鳞癌(P<0.01)。CA125含量在胸水组中腺癌、鳞癌含量明显高于小细胞癌(P<0.01)。5 种标志物单项及联合检测的灵敏度肺癌胸水组均高于肺癌血清组,肺癌胸水中5项联合检测后灵敏度可达99.11%。结论:肺癌组胸水中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物联合检测有利于良恶性胸水的鉴别诊断,联合检测可以提高肺癌诊断的灵敏度,当肿瘤标志物显著升高时,CEA可作为肺腺癌的肿瘤标志物;CYFRA21-1可作为肺鳞癌的肿瘤标志物;NSE和Pro-GRP可作为小细胞癌的肿瘤标志物;CA125可作为非小细胞肺癌的肿瘤标志物。     

肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值

 目的　探讨胸腔积液4种肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值。方法　采用电化学发光免疫法检测126例胸腔积液患者（其中恶性组52例,良性组74例）癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原15-3（CA15-3）和细胞角蛋白片段19（CYFRA21-1）水平, 并计算上述指标单独和与CEA联合检测在诊断中的敏感度、特异度、准确度和约登指数（YI）。结果　恶性组4种肿瘤标志物水平均明显高于良性组（P＜0.01）。单项检测各种肿瘤标志物的敏感度以CA125最高（90.4 %）,特异度以CYFRA21-1最高（79.7 %）,诊断准确度以CEA和CYFRA21-1最高（71.4 %）,YI以CEA最高（0.41）。联合检测较单项检测敏感度、准确度和YI明显提高,其中CEA、CYFRA21-1和CA15-3三项联合效果最好,敏感度为92.3 %,特异度为78.4 %,准确度为84.1 %,YI值最高为0.71。四项联合敏感度为94.2 %,特异度为75.7 %,准确度为83.3 %,YI值为0.70,与三项联合结果相比差异无统计学意义（P＞0.05）。结论　单项检测的诊断价值有限,CEA、CYFRA21-1和CA15-3三项联合效果最好、最经济,可指导患者恰当选择进一步的侵入性检查手段。     

血清肿瘤标志物单项及联合检测在肺癌诊断中的临床价值

目的探讨血清癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)、细胞角蛋白19片断(Cytokeratinfragment 19,CYFRA21-1)、神经特异性烯醇化酶(Neuron-specific enolase,NSE)、鳞状细胞抗原(SCC-Ag)6种肿瘤标志物单项及联合检测在肺癌诊断中的临床价值。方法采用化学发光免疫法检测92例肺癌患者、92例肺良性疾病患者、92例健康体检者的血清CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag表达水平。结果肺癌患者的血清肿瘤标志物CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag的表达均明显高于肺良性疾病患者和健康体检者(P均<0.05);6种肿瘤标志物对肺癌诊断的灵敏性和准确度分别为:CEA(51.1%、73.3%)、CY-FRA21-1(58.7%、73.9%)、CA125(38.0%、71.4%))、CA19-9(27.2%、70.3%)、NSE(26.1%、65.9%)、SCC-Ag(35.9%、71.0%),而六者联合检测的灵敏性和准确度分别为92.4%和83.7%,明显高于各单项检测(P<0.05)。结论血清肿瘤标志物CEA、CA19-9、CA125、CYFRA21-1、NSE、SCC-Ag是诊断肺癌较好的标志物,六者联合检测可明显提高肺癌诊断的灵敏性和准确度。     

Malignant pleural effusions

Opinion statement Malignant pleural effusions contribute to considerable morbidity in cancer patients and generally portend an overall poor prognosis. Treatment of malignant pleural effusions is palliative; therefore, quality of life issues, as well as the risks and benefits of the therapeutic options, become more critical. In my opinion, factors such as in patient versus outpatient management and associated procedural discomfort are important in the decision-making process, and the patient should participate in these subjective con-siderations. It is difficult to compare results and determine the true efficacy of different techniques and agents because endpoints and response criteria as well as the extent and method of follow-up vary. In addition, the etiology of the primary complaint, dyspnea, is frequently multifactorial. However, malignant effusions recur, and therefore repeated thoracentesis, especially if the fluid rapidly reaccumulates, is usually not a good long-term solution unless the patient’s overall prognosis and current condition prohibits a more invasive option. The standard option for recurrent effusions is insertion of a chest tube. If the lung re-expands, chemical pleurodesis is attempted to achieve adherence of the visceral to the parietal pleura. Sterilized talc is the best sclerosant; it has good efficacy and cost effectiveness and can be administered easily as a slurry at the bedside via a chest tube with minimal patient discomfort and without more aggressive and invasive procedures.     

Malignant pleural effusions.

Recurrent malignant pleural effusion is a relatively common problem that often occurs many months before the terminal stages of a patient's malignant disease. Despite careful evaluation, it is often impossible to identify the exact physiologic cause of an effusion and difficult to identify a pragmatic course of therapy. Aggressive management including chest tube drainage, with or without instillation of inflammation-inducing drugs, and radiotherapy or surgery in selected cases is indicated for palliative treatment and probably for increased survival. In formulating a treatment plan, attention should be given to a variety of factors including pathogenic forces in the formation of malignant pleural effusion, tissue type of the metastatic malignancy, general clinical status of the patient, the presence of pleural loculations and adhesions, and the exclusion of other non-malignant causes of pleural effusion.     

Differential diagnosis of pleural effusions

Pleural effusion is an important and common clinical finding. Pleural effusions can be readily obtained for analysis, and the examination of the cells therein is considered to be one of the most important diagnostic tools available for differentiating between malignant and non-malignant effusions. The present study was undertaken to test the diagnostic value of the determination of CEA in pleural fluid for a variety of diseases. Sixteen patients with pleural effusions were studied. Seven patients had carcinoma of the cervix, 7 of the ovary and 2 of the corpus. The positive rate of malignant cells was 81%. Among malignant effusions, only 44% of patients showed a CEA value above 10 mg/ml. This investigation suggests that cytological examination of pleural fluid is of considerable clinical significance for diagnosing the nature of pleural effusions, and effusion fluid CEA assay may provide a useful adjunct in the evaluation of effusion fluids for malignancy.     

Malignant pleural effusions in lymphoproliferative disorders

In order to determine variables that correlate with malignant pleural effusion and mortality in patients with lymphoproliferative disorders and pleural effusion, a retrospective study was performed. Clinical data of hospitalized patients with a lymphoid malignancy and pleural effusion who underwent thoracentesis from January 1993 to December 2002 were collected. A logistic regression analysis was carried out to determine prognostic variables that predict malignant pleural effusion and hospital mortality. There were 86 patients who were admitted on 91 occasions. The median age was 70 years (range 4 - 92) and the male:female ratio was 44:42. Sixty-four patients (74%) had advanced disease, 43 (50%) had received prior chemotherapy and 9 (10%) were in remission. Of 91 cases of pleural effusions, 44 (48%) were bilateral, 80 (88%) were exudates and 48 (53%) were due to malignant involvement of pleura. In multivariate analysis, symptomatic pleural effusion (odds ratio 10.3, 95% confidence interval 1.7 - 98.3), pleural fluid mesothelial cell count < 5% (odds ratio 8.0, 95% confidence interval 1.4 - 58.2), pleural fluid:serum lactate dehydrogenase (LDH) > or =1 (odds ratio 6.4, 95% confidence interval 1.2 - 45.6) and pleural fluid lymphocyte percentage > or =50 (odds ratio 6.4, 95% confidence interval 1.2 - 50) were significantly correlated with malignant effusion. A secondary cancer (odds ratio 11.9, 95% confidence interval 2.3 - 88.8), pleural fluid:serum LDH > or =1 (odds ratio 10.9, 95% confidence interval 2.6 - 64.9), and pneumonia (odds ratio 6.4, 95% confidence interval 1.7 - 28.6) were significantly correlated with hospital mortality. In conclusion, malignant pleural effusion is the common etiology of pleural effusion in patients with lymphoid malignancy. Many clinical and cytochemical markers have discriminatory values in identifying malignant effusion. A high pleural fluid to serum LDH level correlates with malignant pleural involvement and hospital mortality.     

Hyaluronan in pleural effusions and in serum

It has been suggested that a high level of hyaluronan (hyaluronic acid, HYA) in pleural fluid is an indicator of malignant mesothelioma. In 78 consecutive patients with pleural effusion of various causes the HYA concentration was measured in pleural fluid samples and in serum. Nine patients had malignant pleural mesothelioma, and in three of them the HYA level in pleural fluid was 100 mg/l or more. In 42 patients with effusions due to metastatic malignancy, the mean HYA in the pleural fluid was 75 mg/l, and in five the HYA level was above 100 mg/l. Cardiac insufficiency caused the effusion in 11 patients, of whom two had a level above 100 mg/l in pleural fluid. Four patients had a serologically confirmed viral infection and had HYA levels in pleural fluid of 8, 157, 335, and 554 mg/l, respectively. One patient had postinfectious effusion with an HYA level in pleural exudate of 748 mg/l, the highest in this investigation. Two patients had benign asbestos pleural effusions, and both had high pleural HYA levels (256 and 490 mg/l, respectively). The serum HYA values were much lower than in the pleural fluid, namely from 15 to 480 micrograms/l; the levels were independent of the levels in the pleural fluid. Thus, a high level of HYA in pleural fluid is not specific for mesothelioma but can occur in other malignant or benign diseases, and a low level does not exclude mesothelioma.     

Ratios of pleural fluid to serum immunoglobulins in malignant pleural effusions

Pleural fluid and serum protein electrophoresis and quantitative immunoglobulin measurements were carried out in patients with pleural effusions. The mean pleural fluid/serum ratios of IgA, IgG, and IgM were elevated in patients with malignant pleural effusions compared with patients with nonmalignant pleural effusions (P less than 0.04). The sensitivity of a pleural/serum IgA, IgG ratio P greater than 0.6 was 46%, 69%, respectively, and for IgM ratio greater than 0.5 was 28%. The specificity for these same ratios was 89%, 74%, and 100% respectively.     

Optimal therapy of malignant pleural effusions

A randomized phase III trial of bleomycin, tetracycline and talc following chest tube drainage and a meta-analysis of relative benefit of bleomycin and tetracycline as sclerosing agents were performed to determine the optimal approach to malignant pleural effusion (MPE). Fifty patients were randomized to receive bleomycin (n=16), tetracycline (n=19) or talc (n=16) following chest tube drainage. Treatment groups were balanced for pretreatment characteristics. The study was ended prematurely because of the removal of parenteral tetracycline from the market. Overall, 52% of randomized patients had successful control of effusion 30 days after sclerosis. There were no differences between any of the three treatment groups in terms of 30 day control of effusion, overall survival (6 months), resclerosis rate, pain with sclerosis, fever, or duration of hospitalization (6 days). A meta-analysis was performed using the four previously reported trials of tetracycline vs. bleomycin and revealed a 20.6% advantage to the use of bleomycin (95% C.I. 7.9%-33.3%) (p=0.002). This phase III failed to demonstrate a significant difference between the three agents in terms of control of MPE at 30 days, side effects or survival. However, because of small sample size, this study lacks sufficient power to observe potentially clinically important differences between treatment groups. Inclusion of data from four previous trials in a meta-analysis showed that bleomycin may be superior. The median duration of hospitalization and the overall success rate of all three sclerosing agents in this study argue convincingly that new approaches to palliate MPE are needed.