TB-Ab-IgG ADA和CEA对良恶性胸水鉴别诊断意义

目的　探讨胸水结核抗体 (TB-Ab-IgG)、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价值。方法 采用DIGFA法、Giusti改良法和放射免疫法对 92例胸腔积液行胸水TB Ab IgG、ADA和CEA检测分析。 结果 TB Ab IgG在结核性、癌性和其它组胸腔积液中的阳性率分别是 81.8%、12 .8%和 1.1% ,特异性为 87.5 % ;ADA活性在结核性和癌性胸腔积液中分别为 (5 9.6± 2 8.8)U/L和 (2 4 .7± 11.5 )U/L(P <0 .0 1) ,CEA为 (8.5± 7.3)ng/mL和 (6 0 .2± 39.6 )ng/mL(P <0 .0 1) ,ADA在其它组胸腔积液中为 (44 .6± 2 6 .5 )U /L ,与结核性胸腔积液相比 (P >0 .0 5 )。结论 胸腔积液TB Ab IgG、ADA、CEA检测对良恶性胸腔积液有鉴别价值。     

瘦素、脂联素联合癌胚抗原在恶性胸腔积液中的诊断价值

目的 探讨瘦素(Lp)、脂联素(Adipo)和癌胚抗原(CEA)对恶性胸腔积液诊断的临床意义。方法 42例良性和36例恶性胸腔积液患者的胸水和血清标本中Lp、Adipo含量采用双抗体夹心酶联免疫吸附法测定,CEA含量采用放射免疫分析法来测定。结果恶性组胸水与血清Lp、CEA含量高于良性组(P值均＜0.01);恶性组胸水与血清Adipo含量低于良性组(P值均＜0.01);Lp、Adipo和CEA对诊断恶性胸腔积液的敏感性分别是81.0％、76.2％和64.7％,特异性分别是74.0％、77.8％和88.1％,阳性似然比分别是3.12、3.43和5.44;指标联合诊断中以Lp和Adipo分别与CEA联合诊断功效较好,其敏感性和特异性分别是52.4％、96.9％和49.3％、97.4％,阳性似然比分别是16.90和18.96。结论 恶性胸腔积液患者的血清与胸水中Lp、Adipo与CEA浓度对诊断恶性胸腔积液有临床价值,其中以胸水中Lp和Adipo分别与CEA联合诊断功效较好。     

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。     

Tenascin-c和癌胚抗原检测在恶性胸腔积液中的诊断价值

目的探讨肌腱蛋白C(Tenascin C,Tn-C)和癌胚抗原(CEA)联合检测在肺癌所致胸腔积液中的表达及其临床意义。方法采用酶联免疫吸附(ELISA)法及电化学发光法分别检测60例肺部良性疾病所致胸腔积液和60例恶性胸腔积液中Tn-C和癌胚抗原(CEA)的表达,分析Tn-C蛋白的表达与临床特征及肺癌诊断的关系。结果恶性组患者胸腔积液中Tn-C的表达水平高于对照组(P0.05),Tn-C在胸水中的表达与患者的性别、吸烟状况、肿瘤大小、病理分期及病理分型无关(P0.05),与淋巴结的转移有关(P0.05);两组患者的Tn-C血清浓度无统计学差异(P0.05)。根据ROC曲线,以Tn-C浓度为41.508ng/ml为最佳诊断临界点,此点所对应的诊断恶性胸腔积液(MPE)敏感性为90%,特异度为46.67%,联合CEA诊断的灵敏度为80%,特异度为98.3%。结论 Tn-C在肺癌所致恶性胸腔积液中的表达水平较高,与CEA联合检测可提高恶性胸腔积液的诊断灵敏度及特异度,故Tn-C可作为肺癌诊断的良好标记物。     

胸水及血清中癌胚抗原水平测的临床意义

本文利用放免方法分析了31例胸腔积液患者胸水、血清的癌胚抗原(CEA)水平及其比值(其中11例为癌性胸水,20例为结核性胸水),肿瘤患者胸水及血清中的CEA(ug/L)水平明显高于结核患者(胸水30.216±2.313,10.547±3.127,P＜0.001;血清16.726±2.24,7.635±2.365,P＜0.001),肿瘤患者胸水/血清CEA值超过1.5,而结核患者低于此值.连续检测肿瘤患者胸水及血清CEA水平及其比值有升高的趋势,有助于临床胸水性质的诊断.     

白细胞介素6与癌胚抗原联检对老年人结核性及癌性胸液的诊断价值

目的　探讨白细胞介素 ６（ Ｉ Ｌ６）及癌胚抗原（ Ｃ Ｅ Ａ ）对老年人结核性及肺癌胸膜转移所致胸腔积液的诊断价值。方法　用酶联免疫吸附试验（ Ｅ Ｌ Ｉ Ｓ Ａ ）及放射免疫分析法（ Ｒ Ｉ Ａ ）检测了老年人结核性渗出性胸膜炎 ３８ 例及肺癌胸膜转移 ４０ 例胸液及血清 Ｉ Ｌ６、 Ｃ Ｅ Ａ 水平。结果　结核组胸液 Ｉ Ｌ６ 水平及 Ｉ Ｌ６ 胸液／血清比值显著高于肺癌组（ Ｐ＜ ００１, Ｐ＜ ００５）,而肺癌组胸液及血清 Ｃ Ｅ Ａ 水平显著高于结核组（ Ｐ＜ ０００１, Ｐ＜ ００１）。结论　联合检测胸液及血清 Ｉ Ｌ６、 Ｃ Ｅ Ａ 水平对结核及肺癌胸膜转移所致胸腔积液有重要的鉴别诊断价值。     

糖链抗原153与癌胚抗原测定对良恶性胸腔积液的诊断价值

胸腔积液的病因比较复杂，由于缺乏特异性的诊断方法，临床上仍有20％-30％左右的胸腔积液不能明确诊断。最近献报道^[1]，胸腔积液糖链抗原153(CA153)检测对胸腔积液的鉴别诊断有较高价值。我们采用全自动化学发光免疫分析技术，对60例胸腔积液患进行血清和胸腔积液CA153测定，并与同时测定的癌胚抗原(CEA)含量进行比     

多项指标联合检测对良恶性胸水的鉴别诊断价值

目的探讨胸水中腺苷脱氨酶活性(ADA)、干扰素-γ(IFN-γ)和癌胚抗原(CEA)水平对结核性胸水与恶性胸水的鉴别诊断价值。方法检测34例结核性胸水、20例恶性胸水中ADA活性、IFN-γ和CEA水平。结果结核性胸水组胸水中ADA、IFN-γ水平均显著高于恶性胸水组(P<0.01),ADA、IFN-γ水平在结核性胸水组和恶性胸水组中分别为(51.3±13.3)U/L、(1515.07±795.36)ng/L和(12.3±6.96)U/L、(94.42±121.95)ng/L。结核性胸水组CEA水平为(4.0±4.41)ng/L,显著低于恶性胸水组的(37.83±26.36)ng/L,两组比较差异有非常显著性(P<0.01)。结论胸水中ADA、IFN-γ和CEA水平测定有助于良恶性胸水的鉴别诊断。     

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.     

Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis

Background and objective:   Conventional tests are not always helpful in making a diagnosis of malignant pleural effusion (MPE). Many studies have investigated the utility of pleural carcinoembryonic antigen (CEA) in the early diagnosis of MPE. The present meta-analysis determined the accuracy of CEA measurement in the diagnosis of MPE.
Methods:   A systematic review of English language studies was conducted and data on the accuracy of pleural CEA concentrations in the diagnosis of MPE were pooled using random effects models. Receiver operating characteristic curves were used to summarize the overall test performance.
Results:   Forty-five studies met the inclusion criteria for the meta-analysis. The summary estimates for CEA in the diagnosis of MPE were: sensitivity 0.54 (95% CI: 0.52–0.55), specificity 0.94 (95% CI: 0.93–0.95), positive likelihood ratio 9.52 (95% CI: 6.97–13.01), negative likelihood ratio 0.49 (95% CI: 0.44–0.54) and diagnostic odds ratio 22.5 (95% CI: 15.6–32.5). Analysis of a subset of 11 studies which examined the value of pleural CEA in ruling out a diagnosis of malignant mesothelioma found that the sensitivity and specificity of a CEA level exceeding cut-off values were 0.97 (95% CI: 0.93–0.99) and 0.60 (95% CI: 0.55–0.65), respectively.
Conclusions:   Measurement of pleural CEA is likely to be a useful diagnostic tool for confirming MPE, and is also helpful in the differential diagnosis between malignant pleural mesothelioma and metastatic lung cancer. The results of CEA assays should be interpreted in parallel with clinical findings and the results of conventional tests.     

Diagnostic method for malignant pleural effusion distinguishing malignant mesothelioma from lung cancer using pleural carcinoembryonic antigen and hyaluronic acid levels

Malignant mesothelioma (MM) is difficult to diagnose because of the lack of parenchymal opacities, often revealing minimal or absent pleural thickening. Furthermore, pleural effusion has diverse differential diagnoses, including malignancies, infections, as well as collagen vascular and other benign diseases. In general practice, lung cancer (LC) is the most common malignancy causing pleural effusion; therefore, a simple method using pleural diagnostic markers to differentiate between LC and mesothelioma is crucial.We retrospectively reviewed the data of 530 adult patients diagnosed with pleural effusion between January 2010 and December 2020 in an outpatient or inpatient setting. Patients with pathologically diagnosed MM or LC with cytologically positive (class IV or V) pleural effusion were analyzed, and the characteristics of these 2 diseases were compared.During the study period, 27 patients diagnosed with MM and 100 patients diagnosed with LC were enrolled. Receiver operating characteristic curve analysis demonstrated that pleural carcinoembryonic antigen (CEA) and hyaluronic acid (HA) could discriminate MM from LC with an area under the curve of 0.925 (95% confidence interval [CI]: 0.879–0.972, P < .001) and 0.815 (95% CI: 0.686–0.943, P < .001), respectively. To diagnose MM, the accuracy of pleural HA >30,000 ng/mL revealed a sensitivity of 75.0%, specificity of 72.6%, and odds ratio of 7.94 (95% CI: 2.5–25.2, P = .001); pleural CEA <6.0 ng/mL revealed a sensitivity of 95.2%, specificity of 84.9%, smaller negative likelihood ratio of 0.06, and odds ratio of 112.5% (95% CI: 14.4–878.1, P < .001). Multiple logistic regression analysis revealed that these 2 parameters could discriminate MM from LC, with a hazard ratio of 23.6 (95% CI: 2.437–228.1, P = .006) and 252.3 (95% Cl: 16.4–3888.1, P < .001), respectively, and their combination had a high specificity of 98.3%.Pleural CEA (≥6.0 ng/mL) can rule out MM with a high degree of certainty, and the positive results for combination of pleural CEA <6.0 ng/mL and HA >30,000 ng/mL can confirm MM with high specificity, prior to cytological or pathological examinations.     

癌胚抗原和C-反应蛋白联合检测在良恶性胸腔积液鉴别诊断中的意义

目的探讨肿瘤标记物癌胚抗原(CEA)和C反-应蛋白(CRP)联合检测在良、恶性胸腔积液鉴别诊断中的临床意义。方法采用免疫放射法分别检测23例恶性胸腔积液(恶性组)和35例良性胸腔积液患者(良性组)胸水样本中CEA含量和CRP水平,并进行对比分析。结果恶性组患者胸水样本中CEA含量明显高于良性组(P<0.05),CRP水平明显低于良性组,差异有统计学意义(P<0.001),采用胸水中CEA含量及CRP联合检测诊断良、恶性胸腔积液的灵敏度、特异性和准确率分别为65.7%、70%和67.2%。结论联合检测胸腔积液中CEA和CRP水平在良、恶性胸腔积液鉴别诊断中具有重要的临床价值。     

ADA、CRP和CEA在胸腔积液诊断中的意义

目的探讨腺苷脱氨酶（ADA）、C反应蛋白（CRP）、癌胚抗原（CEA）在胸腔积液中鉴别诊断的意义。方法收集已确诊的胸腔积液标本76例（结核性胸腔积液29例、癌性胸腔积液38例和化脓性胸腔积液9例）,检测胸腔积液中ADA、CRP和CEA数值,并进行各组间统计学分析。结果ADA在结核性胸腔积液及化脓性胸腔积液明显升高,在癌性胸腔积液明显偏低（P〈0．01）。CRP在化脓性胸腔积液升高最明显,在结核性胸腔积液次之,在癌性胸腔积液中值最低,三者之间比较有显著差异（P〈0．01）。CEA在癌性胸腔积液中均值明显高于结核性胸腔积液和化脓性胸腔积液组（P〈0．01）。结论ADA、CRP和CEA联合监测对胸腔积液的鉴别诊断有较好的意义。     

The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with non-malignant pleural effusion

OBJECTIVE: The aim of this study was to evaluate the false positive rate for pleural fluid carcinoembryonic antigen (CEA) level in non-malignant pleural effusions and to determine whether the falsely elevated CEA level has any relation to other biochemical parameters of pleural effusions. METHODOLOGY: We performed a retrospective analysis of 654 consecutive patients with a pleural effusion admitted to the pulmonary department of a tertiary referral teaching hospital from March 1997 to March 1999. The aetiology of the pleural effusions were classified as tuberculosis (n = 262), malignancy (n = 204), pneumonia (n = 145), exudates of other origin (n = 28) and transudate (n = 1). RESULTS: A false positive result for pleural fluid CEA level (> 5 ng/mL) was registered in 13.8% of non-malignant pleural effusion cases: empyema (38.6%), parapneumonic effusion (14.7%), exudates of other origin (14.3%), tuberculosis (7.3%) and transudate (6.7%). In analysis of the subgroup with false positive results for pleural fluid CEA level, the CEA level of non-malignant pleural effusion showed a significant relationship to the severity of pleural inflammation in terms of the following variables: LDH (rs = 0.4201, P= 0.001), adenosine deaminase (ADA) (rs = 0.4440, P= 0.0004), white blood cell count (rs = 0.4266, P= 0.0004), polymorphonuclear cell percentage (rs = 0.5080, P= 0.0001), and polymorphonuclear cell count (rs = 0.5095, P= 0.0002). In the parapneumonic effusion and empyema groups, the changes in pleural fluid CEA level exhibited a positive association with the changes in the pleural fluid ADA level (rs = 0.8143, P= 0.0002). CONCLUSIONS: The results from our series indicated that false positive results for pleural fluid CEA level were most commonly observed in patients with empyema and parapneumonic effusion and the CEA level showed a significant correlation to the indices of pleural inflammation. The serial measurement of pleural fluid CEA level may be useful as a means of monitoring resolution of pleural inflammation and excluding the possibility of a malignant pleural effusion.     

恶性胸腔积液的诊断研究进展

恶性胸腔积液(malignant pleural effusion,MPE)是指细胞病理学证实胸腔积液中有脱落的肿瘤细胞或胸膜组织活检证实存在肿瘤细胞。MPE是由肿瘤直接侵袭胸腔或诱发炎症导致,最常继发于肺癌(尤其是腺癌),其次是乳腺癌,二者所致的MPE占其总数一半以上[1]。第三位是霍奇金淋巴瘤和非霍奇金淋巴瘤,其他病因还包括恶性血液系统肿瘤、胃肠道肿瘤、妇科恶性肿瘤、间皮瘤等[2]。     

胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.     

肿瘤相关抗原RCAS1与恶性胸腔积液

RCAS1可促进肿瘤细胞生长、转移及逃避机体免疫监测,诱导外周免疫细胞生长抑制、凋亡,肿瘤新生血管形成及结缔组织重塑.本文从恶性胸腔积液的发病机制着手,重点阐述RCAS1在恶性胸腔积液发生、发展中的作用.