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。

Diagnostic value of tumor markers assays in benign and malignant pleural effusions

Objective To evaluate the diagnostic value of four common pleural fluid tumor markers.Methods A total of 126 patients (52 with definite malignant effusions, and 74 with benign effusions) were enrolled. Tumor markers carcinoembryonic antigen (CEA), cancer antigen 125(CA125), carbohydrate antigen 15-3 (CA 15-3) and cytokeratin 19 fragments (CYFRA21-1)] in pleural fluid were determined by electrochemiluminescence immunoassay. The sensitivities, specificities, accuracies and youden index(YI) of single and combination of those markers were calculated. Results Malignant pleural effusions had higher levels of pleural fluid markers than effusions due to benign conditions. CA125 had the highest sensitivity (90.4 %), and CYFRA21-1 had the highest specificity (79.7 %), CEA and CYFRA21-1 had the highest accuracy (71.4 %), CEA had the highest YI (0.41). The combination of several serum tumor markers had higher sensitivities than the single marker for diagnosis of malignant pleural effusion. When the three tumor markers were combined with CEA, the combination of CEA, CYFRA21-1 and CA15-3 yielded the best results,with a sensitivity of 92.3 %, a specificity of 78.4 %, and an accuracy of 84.1%, YI of 0.71, while the combination of four tumor markers had a sensitivity of 94.2 %, a specificity of 75.7 %, and an accuracy of 83.3 %, YI of 0.70, and there was no statistical significance between the two combinations (P ＞0.05).Conclusion Single tumor marker had limited diagnostic value for malignant pleural effusions, while CEA,CYFRA21-1 and CA15-3 yielded the best and the most economic method, that guiding the selection of patients who might benefit from further invasive procedures.