CEA及CA19-9在良、恶性胸腔积液鉴别诊断中的价值

目的:探讨CEA及CA19-9对良、恶性胸腔积液的鉴别诊断价值。方法:回顾分析100例各类胸腔积液患者的临床资料及胸腔积液CEA、CA19-9水平,根据病因将胸腔积液患者分为良性组和恶性组,再根据恶性胸腔积液患者CEA与CA19-9的分泌特性将其进一步分成"分泌型"与"非分泌型",比较良、恶性胸腔积液CEA及CA19-9水平、作ROC曲线并进一步分析CEA与CA19-9对良、恶性胸腔积液的鉴别诊断价值。结果:恶性胸腔积液中CEA及CA19-9水平均显著高于良性组(均P0.01),剔除"非分泌型"恶性胸腔积液病例后,CEA、CA19-9鉴别诊断良、恶性胸腔积液ROC曲线下面积分别为0.930和0.818,最佳诊断切点CEA为4.35μg/L,CA199为20.60U/ml。CEA、CA19-9及CEA联用CA19-9对良、恶性胸腔积液的诊断效率分别为89.36%、92.98%和94.68%。结论:胸水中CEA及CA19-9检测适用于良性与"分泌型"恶性胸腔积液的鉴别诊断,二者联合检测可明显提高诊断的敏感性和特异性。

Value of CEA and CA19-9 in differential diagnosis of benign and malignant pleural effusion

Objective：To investigate the value of Carcinoembryonic antigen （CEA） and Carbohydrate antigen 19-9 （CA19-9） in pleural effusion for the differential diagnosis of benign and malignant pleural effusion. Method： The clinical information and CEA, CA19-9 levels in pleural effusion of 100 patients with pleural effusion were ret- rospectively analyzed. Patients were divided into the benign group and the malignant group according to their etiology, malignant effusions were further categorized into secreting cancers and non-secreting cancers. The levels of CEA and CA19-9 in pleural effusion were measured and compared, ROC curve analysis was performed to determine analyte cutoffs, and cutoff performance was examined in various subsets of malignancies. Result： The CEA and CA19-9 levels in pleural effusion of the malignant group were significantly higher than those of the benign group （all P〈0.01）. The area under the curve （AUC） for CEA and CA19-9 were 0. 930 and 0. 818, the cutoff values were ≥4.35μg/L and ≥20.60 U/ml respectively when the non-secreting malignancies were excluded from the analysis. The utility of CEA, CA19-9, CEA and CA19-9 together yielded a diagnostic efficiency of 89.36%, 92.98 % and 94.68% respectively. Conclusion：It would be helpful to detect CEA and CA19-9 in pleural effusion for the differentiation of benign and secreting malignant effusion, the sensitivity and accuracy of diagnoses of secreting malignant effusion could be increased by the combined detection of CEA and CA19-9 in pleural effusion.