细胞角质蛋白19片段与癌胚抗原联合检测对良恶性胸腔积液的鉴别 …

目的 探讨细胞角质蛋白１９片段（ＣＹＦＲＡ２１－１）与癌胚抗原（ＣＥＡ）检测对结核性胸水与癌性胸水的鉴别诊断价值。方法 对胸水患者１０８例（癌性６８例,结核性４０例）分别测定其血清,胸中中ＣＹＦＲＡ２１－１和ＣＥＡ浓度。结果 １两种肿瘤标记物浓度在恶性胸水中明显地结核性胸水;２．癌性胸水中ＣＹＦＲＡ２１－１浓度明显高于血清浓度,而胸水中ＣＥＡ浓度与血清中浓度相比无显著性差异;３．胸水ＣＹＦＲＡ２１     

5种标志物对癌性胸液的诊断价值

测定４８例癌性胸液和３３例良性胸液中癌胚抗原（ＣＥＡ）、糖链抗原５０（ＣＡ５０）、α－抗胰蛋白酶（α－ＡＴ）、唾液酸（ＳＡ）及铁蛋白（Ｆｒ）含量，评价其鉴别诊断价值。结果：①癌性胸液组ＣＥＡ、ＣＡ５０水平显著高于良性胸液组（Ｐ＜００１），分别以大于１０μｇ／Ｌ和１２ｋＵ／Ｌ为阳性界值，ＣＥＡ和ＣＡ５０对癌性胸液的诊断敏感性分别为７７１％和６６７％，特异性均为９７％。②ＣＥＡ、ＣＡ５０在癌性胸液中分布无显著相关性（ρ＜０４，Ｐ＞００５），可以互补。两指标联合测定建立判断函数，对癌性胸液的诊断敏感性、特异性和准确率分别为７５％、１００％和８４２％。③α－ＡＴ、ＳＡ、Ｆｒ在癌性胸液和良性胸液中含量无显著性差异（Ｐ＞００５），无鉴别诊断价值     

多指标联合检测诊断老年人恶性胸腔积液

对５５例老年恶性胸腔积液患者，采用胸液脱落细胞光镜及荧光法检测，胸膜活检，胸液癌胚抗原（ＣＥＡ）及铁蛋白等多项检查方法诊断。其结果为：光镜瘤细胞检出率７２．７％；胸液ＣＥＡ阳性率（≥１２μｇ／Ｌ）６９．１％；ＡＯＦ，ＨＯＦ，ＩＧＦ三种荧光法检测阳性率分别为９０．９％，８５．４％，７６．４％；胸膜活检７例中，３例阳性；胸液铁蛋白值，３５例恶性组与３０例良性组均升高，差异无显著性。并对各项检查及临床…     

胸液癌胚抗原、可溶性白细胞介素－2受体浓度及核仁组成区嗜银染色计数对恶性胸液的诊断价值

本文对２４例恶性胸腔积液患者测定胸液的癌胚抗原（ＣＥＡ）、可溶性白细胞介素－２受体（ＳＩＬ－２Ｒ）浓度及核仁组成区嗜银染色（Ａｇ－ＮＯＲ）计数，并以２０例结核性胸膜炎患者做对照研究。结果表明：恶性胸液组ＣＥＡ为４７．３１±２１．３２μｇ／Ｌ，明显大于结核性胸液组（３．５８±３．０７μｇ／Ｌ）（Ｐ＜０．００１）。恶性胸液组Ａｇ－ＮＯＲ计数４．５８±１．１９个／细胞，明显大于结核性胸液组（１．５１±０．４０个／细胞）（Ｐ＜０．０１），而ｓＩＬ－２Ｒ结核组为１０６１．７８±４５５．３０ＫＵ／Ｌ，大于恶性胸液组（４４２．１９±２８３．７７ＫＵ／Ｌ），（Ｐ＜０．０１）。提示三项指标同时检测，综合分析有利于恶性胸液的诊断。     

多种抗结核分支杆菌抗体和胸膜活检对结核性胸膜炎诊断价值

目的：探讨多种抗结核分支杆菌抗体和胸膜活检术对结核性胸膜炎诊断价值。方法：对121例结核性膜炎（合并肺结核60例），44例癌性人患者进行血清，胸液四项抗结核抗体测定（抗PPD－IgG、LAM-IgG卡、TB－Dot卡、ICT－TB卡），对72例结核性胸膜炎病人进行胸膜活检病理检查。结果：血清四项抗体检测结核阻阳性率分别为75．6％、30．7％、44．7％、35．1％；癌性组为43．2％、17．1％、11．4％、2．6％。,胸液四项抗体检测结核组阳性率分别为81．7％、24．0％、27．1％、22．7％；癌性组为51．2％、14．7％、5．9％、2．85。血清和胸液结核组均比癌性组高，合并肺结核高于单纯性胸膜炎组。敏感性以抗PPD－IgG为最高，但特异性差（血清56．8％，胸液48．8％），与癌性胸水存在明显交叉；LAM－IgG卡、TB－Dot卡、ICT－TB卡，特异性血清分别为82．9％、88．6％、97．4％，胸液为85．3％、94．1％、97．2％，比抗PPD－IgG高，但敏感性较低，胸液抗体检测阳率除抗PPD－IgG外略低于血清，以抗PPD－IgG加TB－Dot卡（A组）或抗PPD－IgG与ICT－TB卡（B组）两项阳性组合，且两项均阳性时，特异性，血清可达94．3％100％，胸液可达91．4％－97．2％，阳性率，血清为43．0％－42．98％，胸液为23．7％－17．2％，可提供临床鉴别诊断参考。胸膜活检72例，阳性34例（47．2％），活检阳性与病程密切相关，发病2个月内活检阳性率最高75．5％（25／34），结论：胸膜活检病理学诊断在结核性胸膜炎诊断上有重要价值，多项抗联合测定对结核性胸膜炎诊断有一定参考意义。     

胸液和血清的溶菌酶、癌胚抗原、糖链抗原_(50)比值曲线对结核性和癌性胸液的鉴别诊断价值

对３２例结核性胸液及２３例癌性胸液病人于入院后第１，４，８天分别检测胸液及血清中的溶菌酶（ＬＺＭ）、癌胚抗原（ＣＥＡ）和糖链抗原５０（ＣＡ５０），并分别计算其比值，绘出平均比值动态变化曲线。结果３２例结核性胸液ＬＺＭ平均比值动态变化曲线逐渐增高，２３例癌性胸液曲线逐渐下降；３２例结核性胸液ＣＥＡ平均比值动态变化曲线逐渐下降，２３例癌性胸液曲线逐渐增高；两组ＣＡ５０平均比值动态变化曲线改变不明显。说明胸液血清中ＬＺＭ、ＣＥＡ平均比值动态变化曲线在结核性和癌性胸液鉴别诊断中有意义，而ＣＡ５０胸液和血清平均比值动态变化曲线在鉴别中意义不大     

四项肿瘤标志物测定对老年人良恶性胸腔积液鉴别诊断的价值

目的探讨测定癌胚抗原（ＣＥＡ）、糖类抗原（ＣＡ５０、ＣＡ１９－９、ＣＡ１２５）对老年人良恶性胸腔积液的鉴别诊断价值。方法分别测定老年良性和恶性胸腔积液患者血清和胸水的ＣＥＡ、ＣＡ５０、ＣＡ１９－９、ＣＡ１２５水平，用并联法评价多项肿瘤标志物联合应用的诊断价值。结果恶性胸腔积液患者血清和胸水中ＣＥＡ、ＣＡ５０、ＣＡ１９－９水平分别为３１．６±８．５μｇ／Ｌ、２８．０±９．５ｋＵ／Ｌ、４０．５±１６．４ｋＵ／Ｌ和４８．２±９．４μｇ／Ｌ、４５．８±７．１ｋＵ／Ｌ、５４．０±１８．４ｋＵ／Ｌ，均显著高于健康对照组和良性胸液患者，且胸水／血清比值＞１。胸水ＣＡ１２５水平在良恶性胸腔积液之间差异无显著性。ＣＥＡ和ＣＡ５０联用时敏感性为８６．４％，再加ＣＡ１９－９的３项联用，则敏感性达９７．７％。结论ＣＥＡ、ＣＡ５０、ＣＡ１９－９中二项或三项联合检测有一定诊断意义，如结合胸液／血清比值＞１，则诊断意义更大。     

血清细胞角蛋白19片段检测对肺癌的临床意义

目的确定我国肺癌患者血清细胞角蛋白１９片段（ＣＹＦＲＡ２１－１）浓度阈值，探讨其临床应用价值。方法应用单克隆抗体（Ｋｓ１９．１和ＢＭ１９．２１）检测７２例初次确诊肺癌患者和５０例肺良性疾病患者以及３３例治疗后肺癌患者血清ＣＹＦＲＡ２１－１水平。采用ＲＯＣ曲线确定ＣＹＦＲＡ２１－１浓度阈值。结果（１）肺癌患者血清ＣＹＦＲＡ２１－１水平显著高于肺良性疾病患者（Ｐ＜０．００１），鳞癌显著高于其它病理类型，且其浓度随临床分期升高而升高。（２）当阈值定为５．５μｇ／Ｌ时，ＣＹＦＲＡ２１－１检测肺癌的敏感性、特异性分别为６３％和９４％。鳞癌敏感性最高为７８％。（３）ＣＹＦＲＡ２１－１检测非小细胞肺癌的敏感性随临床分期升高而升高。（４）ＣＹＦＲＡ２１－１是监测肺癌病情、提示疗效的良好指标。（５）当ＣＹＦＲＡ２１－１作为筛检肺癌的指标时，阈值宜取非小细胞肺癌Ｉ－ＩＩ期ＲＯＣ曲线拐点，但对非小细胞肺癌早期诊断作用有限。结论ＣＹＦＲＡ２１－１是一较好的非小细胞肺癌肿瘤标记物，尤其适用于肺鳞癌     

多指标联合检测鉴别结核性和癌性胸腔积液

多指标联合检测鉴别结核性和癌性胸腔积液陈少贤姚恒臣蒋仲荪蔡孔长徐正阶徐正惠为探讨碳水化合物抗原（ＣＡ）、癌胚抗原（ＣＥＡ）、可溶性白细胞介素２受体（ｓＩＬ２Ｒ）鉴别结核性和癌性胸腔积液（胸液）的价值，对３１例癌性胸液、４４例结核性胸液和３０名健康...     

检测血清和胸液E—选择素对鉴别良恶性疾病的意义

目的 通过检测结核性胸膜炎及癌性胸液患血清及胸液的Ｅ－选择素水平，探讨其对鉴别良恶性疾病的意义。方法 采用酶联免疫吸附法（ＥＬＩＳＡ）检测２５例结核性胸膜炎及２１例癌性胸液患血清及胸液的Ｅ－选择素水平。结果 结核性胸膜炎患血清Ｅ－选择素水平为４４±５μｇ／Ｌ、胸液Ｅ－选择素水平２４±３μｇ／Ｌ。明显高于癌性胸液患血清（２７±４μｇ／Ｌ）及胸液（１１±３μｇ＋Ｌ），且重叠性很小。此外，结核性     

Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural effusion

Study objective: Measurement of cytokine concentration in serum and pleural effusion may be useful in the differential diagnosis of tuberculous pleurisy.Patients and methods: We compared the biochemical properties and concentrations of cytokines in serum and pleural effusion samples of 18 patients with tuberculous pleurisy, 7 patients with parapneumonic pleurisy, and 25 patients with malignant pleurisy.Results: A high value of adenosine deaminase (ADA) was observed in pleural effusion of patients with tuberculosis. The serum concentrations of interleukin (IL)-1-beta, IL-2, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha were similar among the three groups. However, the concentration of IFN-gamma in pleural effusion was high in tuberculous patients, and that of TNF-alpha was high in tuberculous and parapneumonic pleural fluid, but both cytokines were low in malignant pleural fluid. The sensitivity, specificity and accuracy of IFN-gamma in the diagnosis of tuberculous pleurisy were 94%, 100% and 98%, respectively. Similarly, those of TNF-alpha for the diagnosis of infectious pleurisy including tuberculous and parapneumonic pleurisy were 88%, 80% and 84%, respectively.Conclusions: Our results indicate that simultaneous measurement of IFN-gamma and TNF-alpha in pleural effusion is a useful diagnostic tool for differentiating tuberculous pleurisy from parapneumonic and malignant pleurisy.     

细胞角质蛋白19片段与癌胚抗原联合检测对良恶性胸腔积液的鉴别诊断价值探讨

目的探讨细胞角质蛋白19片段(CYFRA21-1)与癌胚抗原(CEA)检测对结核性胸水与癌性胸水的鉴别诊断价值?方法对胸水患者108例(癌性68例?结核性40例)分别测定其血清?胸水中CYFRA21-1和CEA浓度?结果1.两种肿瘤标记物浓度在恶性胸水中明显高于结核性胸水;2.癌性胸水中CYFRA21-1浓度明显高于血清浓度,而胸水中CEA浓度与血清中浓度相比无显著性差异;3.胸水CYFRA21.1的检测结果存在一定的假阳性?结论联合检测CYFRA21-1与CEA对胸水良恶性的鉴别诊断有较高的临床价值?     

Role of pleural viscosity in the differential diagnosis of exudative pleural effusion

OBJECTIVE AND BACKGROUND: Determining the aetiology of an effusion involves assessing if it is an exudate or a transudate. However, a reliable test for determining the aetiology of a pleural effusion is lacking. Pleural viscosity has a high sensitivity and specificity and a high positive and negative predictive value for discriminating exudative and transudative pleural effusions. The aim of this study was to use pleural fluid viscosity to discriminate between various aetiologies of exudative effusions, namely malignant, parapneumonic and tuberculous. METHODS: Seventy consecutive patients (24 women, 46 men, mean age = 67 years) with exudative pleural effusion due to pneumoniae in 24 patients, tuberculous pleurisy in 21 and lung cancer in 25 were studied prospectively. Measurements of pleural fluid and plasma viscosity were performed using Brookfield DV-II viscometer. RESULTS: Pleural viscosity and pleural LDH were highest in the tuberculous pleurisy patients and lowest in the lung cancer patients. Pleural viscosity > or = 1.57 was found to be indicative of tuberculous pleurisy with a sensitivity of 100% and specificity of 95%. Pleural viscosity < 1.39 was found to be indicative of lung cancer with a sensitivity of 100% and specificity of 94%. Pleural viscosity was significantly correlated with pleural albumin (r = 0.34, P = 0.004), protein (r = 0.40, P = 0.001), LDH (r = 0.70, P < 0.001) and plasma viscosity (r = 0.44, P < 0.001), having the most significant value with pleural LDH. CONCLUSION: The pleural fluid viscosity of patients with parapneumonic, tuberculous and malignant effusions are significantly different from each other. Among these groups, tuberculous effusions had the highest viscosity, and malignant effusions from lung cancer the lowest.     

Proinflammatory cytokines and fibrinolytic enzymes in tuberculous and malignant pleural effusions

OBJECTIVES: To measure tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in pleural effusions caused by tuberculosis (TB) and malignancy and their relationship with plasminogen activator inhibitor type I (PAI-1) and tissue type plasminogen activator (tPA), and to compare the differences between tuberculous and malignant pleural effusions. In addition, the relationship between the effusion levels of these parameters and the development of residual pleural thickening was evaluated in the patients with tuberculous pleurisy. DESIGN: Prospective study. MATERIALS AND METHODS: TNF-alpha, IL-1beta, PAI-1, and tPA were measured simultaneously in blood and pleural fluid using an enzyme-linked immunosorbent assay in 33 patients with tuberculous and in 30 patients with malignant pleural effusions. Residual pleural thickening was measured and defined as a pleural thickness of >/= 10 mm found on chest radiographs at the completion of anti-TB chemotherapy in tuberculous pleurisy patients. RESULTS: In both groups, the levels of proinflammatory cytokines and fibrinolytic enzymes were significantly higher in pleural fluid than in blood. The levels of TNF-alpha and PAI-1 were significantly higher in tuberculous than in malignant effusions. In contrast, malignant pleural fluid had significantly higher values of tPA than did tuberculous pleural fluid. In tuberculous effusions, the values of PAI-1 and the PAI-1/tPA ratio correlated positively and the levels of tPA correlated negatively with those of TNF-alpha and IL-1beta. In malignant pleural fluid, positive correlations were found between the values of proinflammatory cytokines (TNF-alpha and IL-1beta) and PAI-1. Residual pleural thickening was found in 9 of 33 patients (27. 3%) with tuberculous pleurisy. The pleural fluid values of TNF-alpha, IL-1beta, and PAI-1 were significantly higher and the concentrations of tPA were significantly lower in tuberculous pleurisy patients with residual pleural thickening. CONCLUSIONS: Compared to malignant pleural effusion, fibrinolytic activity in pleural fluid was reduced in tuberculous effusion. Pleural inflammation caused by TB may enhance the release of proinflammatory cytokines, particularly TNF-alpha, which subsequently may increase PAI-1 and decrease tPA in pleural fluid. The imbalance of PAI-1 and tPA in pleural space may lead to fibrin deposition and pleural thickening.     

Vascular endothelial growth factor and proinflammatory cytokines in pleural effusions

To evaluate the predictive value of vascular endothelial growth factor (VEGF) in the differential diagnosis of pleuritis and its association with other proinflammatory cytokines in pleural effusion, we measured VEGF together with interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha) and soluble intercellular adhesion molecule-1 (sICAM-1) in pleural effusions. We investigated 127 patients with pleural effusion (congestive heart failure: 21; parapneumonic: 27; tuberculous: 41; malignant: 38). We examined standard parameters of pleural effusion and measured pleural effusion VEGF, IL-1beta, TNF-alpha and sICAM-1 using enzyme-linked immunosorbent assay. VEGF level was significantly higher in malignant effusion than in other groups. TNF-alpha level was significantly higher in tuberculous pleurisy than in other groups. In tuberculous pleurisy VEGF level showed significant positive correlations with mononuclear cell counts and all investigated cytokines. The sensitivity and specificity of VEGF in the diagnosis of malignancy was 100 and 84%, respectively (cutoff = 2000 pg/ml). The sensitivity and specificity of VEGF and TNF-alpha in the diagnosis of tuberculous pleurisy (VEGF titer <2000 pg/ml and TNF-alpha titer > 55 pg/ml) was 88.9 and 77.1%, respectively. We propose that measurement of VEGF together with TNF-alpha is helpful in differentiating between tuberculous pleurisy and malignant pleural effusion and that VEGF correlates with proinflammatory cytokines especially in tuberculous pleurisy. We also propose that measurement of pleural VEGF is helpful for the diagnosis of malignant pleural effusion.     

胸水ADA、TB-DNA联合检测在结核性胸膜炎中的诊断运用

目的分析胸水ADA、TB-DNA联合检测对结核性胸膜炎诊断运用价值。方法对我院收治的结核性胸膜炎患者183例、癌性胸水患者65例以及炎性胸水患者49例作为研究对象,分别进行ADA、TB-DNA的检测,并对ADA、TB-DNA在三种疾病中的阳性率以及对结核性胸膜炎的敏感度、特异性以及准确性进行分析。结果结核性胸膜炎患者的ADA含量(72.3±23.2 IU/L)明显高于炎性胸水患者(38.4±12.9 IU/L)以及癌性胸水患者(24.3±6.5 IU/L);ADA、TB-DNA联合检测对结核性胸膜炎的特异性84.2%,敏感性98.91%以及准确性为93.26%。结论对结核性胸膜炎患者采用胸水ADA、TB-DNA联合检测可明显提高其检出率,并有助于对结核性胸膜炎胸水、癌性胸水以及炎性胸水的鉴别。     

High level of interferon gamma in tuberculous pleural effusion

It has been observed that T-lymphocytes of patients with tuberculosis produce interferon gamma (IFN gamma) in vitro. Based on this idea, we studied IFN gamma in pleural fluid and serum. We studied 80 patients with pleural effusion; 30 patients with tuberculous pleurisy had high IFN gamma concentrations in pleural fluid. Patients with malignant pleural effusions, nonspecific pleural effusion, parapneumonic effusions and pleural transudates had low levels. The IFN gamma levels were higher in those with massive tuberculous effusion and apparent pulmonary lesion on x-ray film. We found that the T4/T8 lymphocyte ratio was higher in pleural fluid than in peripheral blood. Numbers of T3 and T4 lymphocytes were higher in tuberculous pleural effusions compared with those in other patients. There is no correlation between IFN gamma levels and lymphocyte subsets in pleural effusion. Perhaps pleural T-lymphocytes produce IFN gamma after stimulation by mycobacterial antigens and this lymphokine activates macrophages, increasing their bactericidal activity against Mycobacterium tuberculosis.     

Diagnostic utility of serum and pleural fluid carcinoembryonic antigen, neuron-specific enolase, and cytokeratin 19 fragments in patients with effusions from primary lung cancer

STUDY OBJECTIVES: To assess the diagnostic values of carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and cytokeratin 19 fragments (CYFRA 21-1) as markers of pleurisy in primary lung cancer. DESIGN: Prospective case-control study. SETTING: A tertiary university hospital. PATIENTS: Thirty-four patients with lung cancer and 16 patients with tuberculous pleurisy. MEASUREMENTS AND RESULTS: Levels of CEA, NSE, and CYFRA 21-1 were measured by immunoassay in the serum and pleural fluid of patients with lung cancer and of patients with tuberculous pleurisy. Patients with lung cancer were found to have significantly higher serum and pleural fluid levels of CEA and CYFRA 21-1 than patients with tuberculous pleurisy. Using cutoff values of 5 ng/mL, 20 ng/mL, and 3.3 ng/mL for serum CEA, NSE, and CYFRA 21-1, respectively, the sensitivities and specificities of these tumor markers were as follows for differentiating malignant effusion from benign: CEA, 68% and 93%; NSE, 34% and 93%; and CYFRA 21-1, 45% and 100%. Using cutoff values of 5 ng/mL, 20 ng/mL, and 45 ng/mL for pleural fluid, the sensitivities and specificities were as follows: CEA, 82% and 94%; NSE, 36% and 94%; and CYFRA 21-1, 61% and 81%. A combination of pleural fluid CEA and NSE increased sensitivity and specificity. CONCLUSIONS: In the diagnosis of malignant effusion associated with lung cancer, the determinations of CEA and NSE in pleural fluid could enhance diagnostic yield better than those of all three tumor markers.     

Use of pleural fluid C-reactive protein in diagnosis of pleural effusions

The aims of the study were to assess whether C-reactive protein (CRP) is a sensitive marker for discriminating between transudative and exudative and pleural effusions to evaluate whether it can be used to distinguish inflammatory pleural effusions from other types of effusion. Pleural fluid and serum CRP levels were obtained in 97 patients with pleural effusion, using an immunoturbidimetric method (Olympus AU-600 autoanalyser). We compared CRP levels between transudates and exudates, inflammatory effusions and other types of effusion. According to the criteria used, 16 patients were included in the transudate group and 81 patients in the exudate group. Pleural fluid CRP levels were significantly lower in the transudate group (P<0.04; 14.9 +/- 4.9 mg l(-1) and 35.5 +/- 4.9 mg l(-1) respectively). Also, the ratio of pleural fluid to serum was significantly lower in the transudate group (P<0.009; 0.8 +/- 0.5 mg l(-1) and 2.8 +/- 0.7 mg l(-1), respectively). In the exudate group, 35 patients had neoplastic effusions, 10 chronic non-specific pleurisy, 19 tuberculous pleurisy, 16 parapneumonic effusion and one Dressler Syndrome. When these sub-groups were compared, the parapneumonic effusion subgroup CRP levels (mean 89 +/- 16.3 mg l(-1)) were significantly higher than those in the other subgroups, other exudate of neoplastic effusion, tuberculous pleurisy and chronic non-specific effusion and the transudate group (P<0.0001; P<0.0001; P<0.0004 and P<0.0001, respectively). The ratio between pleural fluid and serum CRP was significantly higher in the parapneumonic effusion subgroup than in the neoplastic subgroup (P<0.0002; 6.6 +/- 2.7 mg l(-1) and 1 +/- 0.2 mg l(-1), respectively). Pleural fluid CRP levels > 30 mg l(-1) had a high sensitivity (93.7%) and specificity (76.5%) and a positive predictive value of 98.4%. In the differential diagnosis of pleural effusions, higher CRP levels may prove to be a rapid, practical and accurate method of differentiating parapneumonic effusions from other exudate types. Although the high level of CRP obtained in the exudate group may be due to the number of patients with parapneumonic effusion who were included, the pleural CRP level may also be helpful in discriminating between exudative and transudative pleural effusions.     

胸腔镜与蛋白指纹图谱技术在胸腔积液诊断中的应用

目的 探讨胸腔镜与蛋白指纹图谱检测技术（PFT）,在恶性和结核性胸腔积液早期诊断中的作用。 方法 2009年1月至2010年12月福建省福州肺科医院住院经影像学检查发现有胸腔积液,经内科胸腔镜检查、病理学（或细菌学）、胸腔积液蛋白指纹图谱检测临床确诊的121例住院患者,选择无其他并存病,经胸腔镜检测病理确诊的恶性胸腔积液患者30例（Ⅰ组）和结核性胸腔积液患者50例（Ⅱ组）,同时进行胸腔积液蛋白指纹图谱检测,分析其相关蛋白峰值并进行统计学处理。 结果 Ⅰ组和Ⅱ组行蛋白指纹图谱检测,两组间有7个差异蛋白峰（分别为5335、8048、11 700、11 670、15 982、11 683、7700 m/z）,依据蛋白峰值表达情况,以11 670、11 700 m/z的蛋白峰用于建立恶性胸腔积液诊断模型,诊断Ⅰ组阳性率达83.3%（25/30）,Ⅱ组为24.0%(12/50),两组差异有显著统计学意义（χ²=26.55,P<0.01）,倾向于判定恶性胸腔积液;其敏感度为83.3%（25/30）,特异度为76.0%（38/50）;以5335、8048 m/z用于建立结核性胸腔积液诊断模型,2种蛋白峰建立Ⅰ组与Ⅱ组的鉴别诊断模型结果,诊断Ⅰ组阳性率达16.7%（5/30）,Ⅱ组为52.0%(26/50),两组差异有显著统计学意义（χ²=9.86,P<0.01）,倾向于判定结核性胸深积液;其敏感度为52.0%（26/50）,特异度为83.3%（25/30）。 结论 胸液蛋白指纹图谱检测技术简便、快速,是鉴别结核性与恶性胸腔积液特异性标志物的有效手段,但尚需在判读方法上做进一步深入研究。