联合检测胸液端粒酶、CEA、ADA对恶性和结核性胸腔积液的诊断价值

目的探讨端粒酶、癌胚抗原、腺苷脱氨酶联合检测对恶性和结核性胸腔积液的鉴别诊断价值。方法选择恶性胸腔积液31例,结核性胸腔积液35例,采用聚合酶联反应-酶联免疫吸附分析法(PCR-ELISA)检测胸腔积液端粒酶活性,用酶免疫分析法(EIA)检测胸腔积液CEA水平,用比色分析法检测胸腔积液ADA含量,并对测定结果进行统计学处理。结果端粒酶活性测定诊断恶性胸腔积液的灵敏度为0.870,特异度为0.943。CEA诊断恶性胸腔积液的灵敏度为0.744,特异度为0.886。ADA诊断恶性胸腔积液的灵敏度为0.967,特异度为0.971,正确性为0.969。结论端粒酶活性的测定,在良恶性胸水的鉴别诊断中具有重要价值,但存在假阴性和假阳性,若与胸水CEA、ADA联合检测,对良恶性胸水的鉴别诊断意义更大。     

胸腔积液中白细胞对端粒酶活性影响的分析

目的通过免疫磁珠技术去除胸腔积液中的白细胞（WBC）后检测其中肿瘤细胞的端粒酶活性,探讨白细胞对胸腔积液肿瘤细胞端粒酶活性的影响。方法收集15例患者胸腔积液,其中良性胸腔积液5例,恶性胸腔积液10例,应用TRAP—PCR—ELISA法检测分别经免疫磁珠阴性法及密度梯度离心法富集后胸腔积液细胞端粒酶活性。结果利用吸光度差值（△A）定性分析显示去除白细胞前后良恶性胸腔积液端粒酶活性无明显差异（P〉0．05）;利用患者胸腔积液肿瘤细胞相对端粒酶活性值（RTA）定量分析,10例恶性胸水经两种方法富集后的RTA值比较有差异（P〈0．05）,免疫磁珠阴性法富集后恶性胸水肿瘤细胞RTA明显高于密度梯度离心法富集后的恶性肿瘤细胞;5例良性胸水经两种方法富集后的RTA值之间比较无显著性差异（P〉0．05）。结论定量分析显示利用免疫磁珠阴性法富集胸腔积液肿瘤细胞后进行端粒酶活性检测去除了白细胞对肿瘤细胞端粒酶活性的影响,提高了检测的敏感性和特异性,可用于良恶性胸腔积液的鉴别。     

癌胚抗原、腺苷脱氨酶在胸腔积液鉴别诊断中的意义

目的探讨癌胚抗原（CEA）和腺苷脱氨酶（ADA）水平检测在胸腔积液鉴别诊断中的价值。方法分别测定结核性与癌症患者血清和胸腔积液中ADA与CEA,参考我国《全国临床检验操作规程（第三版）》中CEA、ADA的正常值,分别以CEA〉10ug／L,ADA〉20U／L为阳性标准作对照,计算诊断的灵敏度和特异度。结果ADA在结核性胸腔积液组中明显升高,在恶性胸腔积液组中不升高（P〈0．001）;CEA含量恶性胸腔积液组明显高于结核性胸腔积液组,差异具有统计学意义（P〈0．001）。CEA〉10ug／L诊断恶性胸腔积液的灵敏度为70．8％,特异度为100％;ADA〉20U／L诊断结核性胸腔积液的灵敏度为93．3％,特异度为91．7％。结论ADA和CEA检测在胸腔积液的鉴别诊断中具有较高的临床价值。     

联合检测对良恶性胸腔积液的鉴别诊断价值

目的探讨胸腔积液中内皮抑素（ES）、癌胚抗原（CEA）与肿瘤特异性生长因子（TSGF）联合检测对良恶性胸腔积液的鉴别诊断价值。方法收集恶性胸腔积液组40例及良性胸腔积液组38例的胸水标本,采用酶联免疫吸附测定（ELISA）方法检测胸水标本中的ES、CEA、TSGF水平。结果 （1）恶性胸腔积液组胸水ES、CEA、TSGF水平均显著高于良性胸腔积液组,P〈0.01。（2）联合检测恶性胸腔积液ES、CEA、TSGF的敏感度（92.5%）高于单一检测。结论联合检测胸腔积液ES、CEA和TSGF可能有助于良、恶性胸腔积液的鉴别诊断。     

血清及胸腔积液CEA检测联合细胞染色体分析在老年患者恶性胸腔积液诊断中的应用

目的 探讨血清及胸腔积液癌胚抗原（CEA）检测联合细胞染色体分析在老年患者恶性胸腔积液诊断中的应用价值.方法 收集不明原因胸腔积液老年患者48例,按组织病理学诊断结果分为恶性胸腔积液组28例和良性胸腔积液组20例.检测两组患者血清、胸腔积液中的CEA,并对其胸腔积液中的细胞染色体进行分析.结果 单纯采用细胞染色体分析确诊恶性胸腔积液的灵敏度为61％、特异度为95％,血清及胸腔积液CEA检测联合细胞染色体分析确诊恶性胸腔积液的灵敏度为86％、特异度为100％,两者相比,P均＜0.05.结论 血清及胸腔积液中CEA的检测对诊断恶性胸腔积液具有一定价值,尤其胸腔积液CEA,联合细胞染色体分析对诊断恶性胸腔积液的灵敏度和特异度升高.     

心钠素、癌胚抗原在良恶性胸腔积液鉴别中的价值

目的比较心钠素、癌胚抗原在良恶性胸腔积液鉴别诊断中的价值。方法检测36例结核性胸腔积液、40例恶性胸腔积液患者的血清和胸水中的心钠素（ANP）及癌胚抗原（CEA）水平。结果恶性组胸水ANP水平明显高于结核组（P〈0.01）;恶性组血清、胸水CEA水平也明显高于结核组（P〈0.01）,但恶性组血清ANP水平与结核组比较,差异无显著性意义（P〉0.05）。结论测定胸腔积液ANP水平是良恶性胸腔积液鉴别的重要方法之一,与CEA测定具有同样重要的临床价值。     

联合检测VEGF、CEA、ADA对结核性与恶性胸腔积液的鉴别诊断价值

目的：探讨血管内皮生长因子（VEGF）、癌胚抗原（CEA）、腺苷脱氨酶（ADA）联合检测对结核性与恶性胸腔积液的鉴别诊断价值。方法：选择胸腔镜检查、并取活检病理确诊的96例胸腔积液患者,分别采用双抗体夹心酶联免疫吸附法（ELISA）、酶联免疫分析法（EIA）、比色分析法检测胸腔积液中VEGF、CEA、ADA的含量、并对统计结果进行分析。结果：恶性胸腔积液组中VEGF、CEA值分别为（307±132）pg／L、（16．3±7．8）μg／L,分别显著高于结核性胸腔积液组的（34±11．2）pg／L、（2．3±1．1）μg／L（均P〈0．01）。恶性胸腔积液组ADA含量为（12．46±4．61）U／L,低于结核性胸腔积液组（44．98±11．78）U／L,两者间差异有统计学意义（P〈0．05）。联合检测VEGF和CEA,对诊断恶性胸水的敏感性为95．4％,特异性为99．8％。结论：检测胸腔积液中VEGF、CEA及ADA对胸水的鉴别诊断有一定的价值,其联合检测综合诊断能提高恶性胸水与结核性胸膜炎的诊断准确率。     

腺苷脱氨酶和癌胚抗原检测对结核性与恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶(ADA)和癌胚抗原(CEA)检测对结核性与恶性胸腔积液的鉴别诊断价值。方法用氨试剂法和ELISA法对118例胸腔积液的ADA和CEA进行检测分析。结果结核组与恶性组ADA活性有显著差异(P0.01)。恶性组与结核组CEA活性有显著差异(P0.01)。结核组和恶性组中ADA的阳性率分别为94.3%和8.7%,差异有统计学意义(P0.01)。恶性组和结核组中CEA的阳性率分别为69.6%和6.9%,差异有统计学意义(P0.01)。ADA≥40 U/L诊断结核性胸腔积液的灵敏度为94.3%,特异度为90.3%。CEA≥10μg/L诊断恶性胸腔积液的灵敏度为69.6%,特异度为93.7%。以ADA≥40 U/L和CEA10μg/L为阳性界值诊断结核性胸腔积液的灵敏度为87.8%,特异度为95.3%。以CEA≥10μg/L和ADA40 U/L为阳性界值诊断恶性胸腔积液的灵敏度为63.5%,特异度为99.2%。结论胸腔积液ADA及CEA检测对结核性与恶性胸腔积液有鉴别诊断价值。     

胸水和血清ADA、CEA联合检测对良恶性胸腔积液的诊断价值

目的探讨胸水／血清腺苷脱氨酶（ADA）、癌胚抗原（CEA）联合检测对良恶性胸腔积液的鉴别诊断价值。方法采用酶连续监测法和酶联免疫（ELISA）双抗体夹心法对119例胸腔积液进行胸水／血清ADA和CEA检测分析。结果CEA在结核性和癌性胸腔积液中的阳性率分别为8．20％和63．6％,特异性91．8％（89／97）。ADA活性在结核性和癌性胸腔积液中分别为（59．62±29．86）U／L和（15．31±7．36）U／L（P〈0．01）。以P—ADA〉40U／L做为诊断结核的临界值,其敏感性为79．3％,特异性为86．4％;以P—ADA／S—ADA〉1为临界值,其敏感性为97．7％,特异性为95．5％。结论胸腔积液ADA、CEA检测对良恶性胸腔积液具有诊断与鉴别诊断价值。     

联合检测肿瘤M2型丙酮酸激酶、CEA对并发胸腔积液的肺癌的诊断价值

目的检测胸腔积液中肿瘤M2型丙酮酸激酶（TumorM2-Pyruvate kinase,Tu M2-PK）和癌胚抗原（carcinoembbry-onicantigen,CEA）,探讨M2-PK和CEA在并发胸腔积液的肺癌患者的临床诊断价值。方法利用夹心ELISA法测定44例良性胸液和35例并发胸腔积液的肺癌患者的M2-PK,CEA值。比较两组之间的差异。结果肺癌并胸腔积液组M2-PK、CEA值分别为（28.45±8.63）U/m l,（19.55±12.93）ng/ml;良性胸液组M2-PK、CEA值分别为（19.48±6.75）U/mL,（7.79±4.47）ng/m l,恶性胸液组中M2-PK和CEA值均明显高于良性胸液组（P〈0.05）。联合检测的灵敏度为82.86%,特异度为63.64%,阳性预测值为64.44%及阴性预测值为82.35%。联合检测胸腔积液中的M2-PK和CEA能够显著提高并发胸腔积液患者的肺癌诊断水平。结论 M2-PK和CEA在恶性胸液组中明显升高,联合检测胸液中M2-PK和CEA可提高对并发胸腔积液的肺癌患者的诊断水平。     

端粒酶活性检测联合癌胚抗原、CA19-9对良恶性胸水的鉴别诊断价值

目的 探讨端粒酶活性联合癌胚抗原(CEA)、CA19-9在鉴别良、恶性胸水中的价值.方法 入选58例胸水患者,用改良的端粒重复序列扩增-酶联免疫吸附试验法检测胸水中脱落细胞端粒酶活性,并测定胸水CEA、CA19-9.结果 恶性胸水中端粒酶活性检出阳性率为85.7%.恶性胸水患者中端粒酶活性、CEA、CA19-9测定结果均明显高于良性胸水患者(P＜0.01).联合端粒酶、CEA、CA19-9共同检测,则敏感性为0.971,特异性为1.000.结论 端粒酶在诊断恶性胸水和鉴别良、恶性胸水中具有重要的价值,联合CEA、CA19-9对良、恶性胸水鉴别诊断意义更大.     

Limited additive value of pleural fluid carcinoembryonic antigen level in malignant pleural effusion

OBJECTIVE: To assess the additive value of pleural fluid carcinoembryonic antigen (CEA.PF) level in the diagnosis of malignant pleural effusion. METHODS: Thoracentesis and closed pleural biopsy were performed in consecutive patients with pleural effusions. CEA.PF, cell analysis, and biochemical, cytopathologic and microbiologic studies were carried out. Further diagnostic interventions were undertaken if initial tests were inconclusive. RESULTS: A total of 176 patients were evaluated. The effusions proved malignant in 78 patients (44%). Benign etiologies were diagnosed in 89 cases, comprising 51 tuberculous pleurisies, 12 empyemas, 26 others. The cause was unknown in 9 patients. Median (range) in ng/ml of CEA.PF were 233 (1-12,500) in malignant vs. 2.5 (0.3-9) in tuberculosis, 1.4 (0.1-2) in transudates, 19.4 (0.6-312) in empyemas, p < 0.001. Receiver operating characteristic curve identified 10 ng/ml as the best cut-off for CEA.PF, yielding a sensitivity of 0.77, a specificity of 0.94, a positive and negative predictive value of 0.92 and 0.82, respectively. Among the 78 patients with malignant effusions, CEA.PF was elevated but initial cytopathologic study was nondiagnostic in 14 patients (18%). Prompted by the raised CEA.PF, further diagnostic interventions were undertaken and secured the diagnosis of malignancy in all of these 14 patients. CONCLUSIONS: CEA.PF level adds limited value on cytopathologic study in the diagnosis of malignant pleural effusions. It potentially identifies 18% of patients with malignant effusions who require further investigations despite negative initial cytopathologic study.     

CEA、CYFRA21-1、TSGF对恶性胸水诊断价值的研究

目的通过对胸水中CEA（癌胚抗原）、CYFRA21-1（细胞角蛋白19片段）、TSGF（恶性肿瘤特异性生长因子）的检测,探讨此三项指标在恶性胸水诊断中的价值。方法应用酶联免疫法（ELISA）对59例恶性胸水和48例良性胸水进行检测。结果恶性胸水组中CEA、CYFRA21-1、TSGF在胸水中的含量明显高于良性胸水组（P〈0．01）。CYFRA21-1在肺鳞癌中表达水平最高,CEA在肺腺癌中表达水平最高。其敏感性和特异性分别为：CEA：81．36％,91．67％;CYFRA21-1：91．53％,79．17％;TSGF：86．44％,89．58％。胸水CEA＋CYFRA21-1＋TSGF联合检测肺癌的的敏感性为93．22％,特异性为60．42％,阳性预测值为84．69％,阴性预测值为86．58％。结论CEA、CYFRA21-1、TSGF的联合检测在恶性胸水的诊断中有重要的I临床应用价值。     

支气管肺泡灌洗液淋巴细胞端粒酶活性检测对肺癌诊断意义

目的通过检测支气管肺泡灌洗液（BALF）中的淋巴细胞的端粒酶活性（TA）,探讨其对BALF端粒酶活性检测的影响,评价TA在肺癌中的诊断意义。方法将52例患者按最终临床诊断结果分为恶性（27例）、良性（25例）两组,用密度梯度离心法分离BALF标本获得淋巴细胞;应用TRAP—ELISA法检测淋巴细胞和同组对照标本的端粒酶活性,结果以OD值表示,计算该方法的敏感性、特异性、阳性预测值、阴性预测值、准确性等,结果用t检验和X^2检验。结果端粒酶活性检测（TA）：25例良性肺病组中只有1例TA检测阳性（1／24）,OD值为0．091±0．027,分离的18例淋巴细胞无1例阳性,OD值为0．064±0．013;27例肺癌中有24例阳性,OD值为0．630±0．350,分离的淋巴细胞有1例阳性,OD值为0．084±0．013,分离的肿瘤细胞全部阳性;TA检测的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为88．9％、95．8％、96％、88．5％、92．2％,经统计分析：恶性和良性两组问TA差异有显著性（P〈0．01）,淋巴细胞的TA对总体对照无明显影响（P〉0．01）。结论BALF中淋巴细胞的端粒酶活性对TA检测结果无明显影响,TA检测可以作为肺癌的诊断方法。     

Diagnostic value of sialic acid in malignant pleural effusions.

In this study, we measured pleural fluid and serum sialic acid levels in 70 consecutive patients hospitalized with pleural effusions and serum sialic acid concentrations in 20 healthy individuals chosen as control group. The cause of 26 pleural effusions was malignancy, and diseases other than malignant neoplasms were determined as the cause of 44 cases. Mean serum sialic acid levels in the patients with malignancies were higher than the levels in patients with nonmalignant diseases and the control group. Mean sialic acid level in the patients with nonmalignant diseases was increased compared with control group, but this increase was not as high as that in the patients with malignancies. In the patients with malignant neoplasms, mean pleural fluid sialic acid content was also higher than that found in other diseases. Sialic acid concentration of pleural fluid was correlated with serum concentration. However, pleural fluid to serum sialic acid ratio in malignant diseases was greater than that in the others. The specificity and sensitivity of pleural fluid sialic acid level in excess of 0.075 mg/ml in distinguishing malignant effusions were 68 percent and 77 percent, respectively. These values for pleural fluid/serum sialic acid ratio with the cut-off level of 0.7 were 55 percent and 65 percent. Our findings indicate that determination of sialic acid level in malignant pleural effusions has a diagnostic value.     

Diagnostic implications of telomerase activity in pleural effusions.

The aim of the present study was to investigate the diagnostic efficacy of telomerase activity for discrimination of malignant and benign pleural effusions. Pleural effusions were collected from 109 consecutive patients in whom the diagnosis was confirmed with cytological and/or histological examinations. Cytological samples were classified as malignant (n=63) and benign (n=46). Telomerase activity was determined with the polymerase chain reaction-based telomeric repeat amplification protocol assay. Telomerase activity was detected in 52 (82.5%) and nine (19.6%) samples from the malignant and benign groups, respectively, which was a significant difference. The sensitivity rate of cytological examination when combined with telomerase activity (92.1%) was significantly greater than that of cytological examination alone (53.9%). The sensitivity and specificity of telomerase activity were 82.5 and 80.4%, respectively. Diagnostic accuracy of telomerase activity was 81.6%. Telomerase activity is a highly sensitive diagnostic biomarker for malignancy and may be used as an adjunct to cytological findings in determining malignant pleural effusions.     

sFasL检测对结核性与恶性胸腔积液鉴别诊断价值的探讨

目的探讨sFasL对恶性胸腔积液与结核性胸腔积液鉴别诊断价值。方法应用ELISA法分别检测32例恶性胸腔积液和43例结核性胸腔积液中sFasL的含量,对结果进行统计学处理。结果结核性胸腔积液组sFasL(13.56±5.38 ng/ml)显著高于恶性胸腔积液组(5.72±2.59 ng/ml),二者具显著性差异(P＜0.001)。以10 ng/ml为临界值,胸腔积液中sFasL>10 ng/ml诊断为结核性胸腔积液的敏感性为81.4%(35/43),特异性为81.3%(26/32),临床诊断符合率为81.4%(61/75)。结论sFasL对结核性、恶性胸腔积液的鉴别诊断有临床实用价值。     

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?